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THE CANON OF MEDICINE
OF AVICENNA

AMS PRESS

NEW YORK

ReP,o,l„ce,l in- /.c-i-;i.,.ss„.Ji of the Trusts of the Unt.sh .11».*-.

A physician and his patient.

From an early .Persian MS. (Add. 27.261. f. 371b)

" \ "Teat sage— a reader of ancient books, Greek, Persian, Latin,
Arabian, and Svriac ; and skilled in medicine and astronomv, both
with respect to their scientific principles and the rules of their
practical applications ; he was experienced in all that bealeth
and hurteth the bodv ; conversant with the virtues of every plant,
dried and fresh, the baneful and the useful. He was versed in the
wisdom of the philosophers, and had compassed the whole range
of medical science and other branches of the knowledge-tree.

Uth Xiglil '—Hiirton; Lane.)

Library of Congress Cataloging in Publication Data

Avicenna, 980-1037-

A treatise on the Canon of medicine of Avicenna.

Original work has title: al-Qanun fi al-tibb.

Bibliography: p.

1. Medicine, Arabic. I. Grmier, Oskar Cameron, tr,

II. Title.' [DEEM: WZ290 A957q bk. 1 ^W^
E128.3-A9732 1973 610 73-12409

ISBN: 0-404-11231-5

U 7

-d- .J i.J

H\/

Reprinted from the edition of 1930, London
First AMS edition published in 1973
Manfuactured in the United States of America

AMS PRESS INC.

NEW YORK, N. Y. 10003

PREFACE

The purpose of the present treatise is two-fold :

(i) To furnish a translation of the First Book of the
Canon of Medicine of Avicenna. The section on Anatomy
has been omitted in favour of the first half of the Be viribus
cordis. This assists in the second object of this treatise. Dis-
tinctively large type is used for the translation.

(2) To present a study of its mystical philosophy {tas-
sawuf), especially showing where this and modern biological
knowledge are reciprocally illuminative.

The words of the late Prof. E. G. Browne may be quoted
here : " Even if we rate the originality of Arabian medicine at
the lowest, I venture to think that it will deserve more careful
and systematic study."

Furthermore, the Thomistic philosophy of human nature
is specially discussed, and its applicability to the Medicine
of the future is definitely enunciated.

A grateful acknowledgment is made to the School of
Oriental Studies, London Institution (University of London)
for_ signal help in the acquisition of the Arabic, Persian, and
Chinese essential to the purposes of the treatise.

O. Cameron Gruner.
London, Becember, 1929.

CONTENTS

A. The Treatise

page

Preliminary Thesis: The Canon of Medicine in relation to

modern thought - - - - - ",".." " *

I. The intellectual culture contemporary with Avicenna

(a) In the central Saracen empire, (b) In the
western Saracen empire, (c) Among the
Chinese.

II. The knowledge presented by the Canon, as compared

with that of to-day (§ 7- 1 8 ) " " " " " ,; 5

(a) The Canon is a precis, (b) The word Canon.
(V) The word " knowledge." (d) Mystical
insight.

III. The basic difference between the Canon and Modern
Medicine (§ 19-22) -----""" 8

IV. Special differences between the Canon and Modern
Medicine (§ 23-37) -------- 1°

(a) Conceptions .known to Avicenna ; not now
recognised, (b) Conceptions known to modern
medicine, but not to Avicenna. (c) Know-
ledge common to Avicenna and modern
medicine.
V Of interest to the Scholar (§ 38) - - - - \

VI. Brief survey of the Intention of this treatise ($ 40-44) 19
The doctrine of Matter and Form (§ 55-108) 39

Death and Destiny (§ 11 1-1 1 5) ------- I 2

The Humours (§ 116, 117) " " " ' " " " " ?,
The basis of Anatomy in the Canon Q 1 18-127) - - - ±03

The doctrine of the Breath (§ 136-150) ------ 12.,

Scholastic psychology (§ 155-165) - - I39.H3

Coloured Plate representing the corporeal and psychical Faculties facing p. 143

The Bath-house (§ 198, 199) ' : " ~ " " " " Ifc

Expiative causes of Disease (§ 201) - - - - " ' P

Chinese sphygmology (§ 208-224, 234, 235)- - - - ' 20 J>

Table of Terminology relative to the Pulse (Latin, Arabic, Chinese) facing p. 289
The doctrine of the pulse (§ 218-220, 225-230, 231-233) - 293-308
Urinalysis, ancient versus modern (§ 238-239) - - - 349

Dietetics (§ 195, 248-253) ------ ' 219 ' 4 \ 4

Ornamental Plate, with special portraits - /<"»»£ P- 553

Concluding Survey (§ 267-300) - - - - " - _ " 553

• Plate : Rembrandt, " The Raising of Jairus' daughter ' - facing p. 567

Appendix: I. Progress; II. Facts-Knowledge-Truth - 569

ri HI. The Materia Medica of the Canon - - 57*

References ----------- 573

CONTENTS vii

B. The Translation page

Introductory words (1-5) - - - 22

BOOK I

. PART I

Thesis I. Definition and Scope of Medicine (6-18) - 25

Thesis II. Cosmology (19-25) - - - - - ' - 34

Thesis III. The Temperaments (26-66) - - - - e 7

Thesis IV. The Humours (67-113) - . . . . ?6

Thesis V. Anatomy (114-135) - - - - - - 93

Thesis VI. General Physiology (136-173) - - - 107

Psychology (174-183) - - - - - - 135

PART II

Disorders of Health

Thesis I. Definition of Terms (191-230) - - - - 156

Thesis II. The Causes of Disease. Etiology (231-451) 173
A. — Unavoidable Causes - - - - _ _ -17s

(i) Extracorporeal.

The influence of seasonal changes on the body - 183
Climate : (a) Latitude, (5) Altitude, (c) Mountains,
(d) Seas, (<?) Winds, (/) Soil, (g) Marshes

(305-332) ■ - - - - - _ . . I9S

(ii) Corporeal. Causes unavoidable because physio-
logical. ------.... 2IO

Dietetics (347-360) - - - - - _ -214

The various kinds of drinking water (361-392) - 221

B. — Facultative Causes of Disease - -" - - 230

Balneology (400-414) ------- 232

Thesis III. The Evidences of Disease.

Semeiology (452-677) -------- 2=57

Sphygmology (515-602) -------- 283

Urinoscopy (603-674) -------- 323

The Alvine Discharge (675-677) - - - - - - 353

PART III

The Preservation of Health (678-904^ - - - . ?e 7
Dietetics (759-814, 855-859) - - '- - - - 394,432

PART IV

The Treatment of Disease (905-1085) ----- 460

BOOKS II-V. Brief List of Contents - - - - 532

Translation of " De Viribus Cordis " (168-173, 1086-1130) 123 K2a

Index - °' ?„t

5/9

PRELIMINARY THESIS

The Relation between the Canon of Medicine of Avicenna

and Modern Thought

CONSIDERATIONS are not wanting which entitle
the Canon of Medicine of Avicenna to an esteemed
position in modern thought. In the first place, there
is the outstanding intellectual culture of the Saracen
Empire during the period of history to which Avi-
cenna belongs. Secondly, in the case of much of his
teaching, it may be.said that the difference from ours
is largely only that his speech is alien, and is apt to be
misunderstood. In these days, the great complexity of the language
with which we express our scientific thought corresponds with the
intricacy of the instruments wherewith facts are elicited. Thirdly,
many of the advances of modern times offer the solutions to the very
theorems and propositions of former times. Finally, ideas are to be
found in his work which provide suggestions for useful research in
the future.

§ I . The importance of idea over material achievement is not
to be forgotten. The achievements of any age are subject to decay
with the lapse of centuries, but the ideas which gave rise to them
remain living through all cycles. Therefore to propose a real place
for Avicenna in modern thought is not to propose a return, as it were,
to old architecture, or the costumes of long ago. It is rather to
render accessible to-day the picture which he painted, and so enable
it to renew its still vital message. It is to play over again the music
which he expressed, and enable perhaps one or two to rejoice in it.
And this without obscuring the issue by discussing nationality, or
schoolsof thought, or evolution of ideas, or technical methods.

If it appear to some a fault that the master appears to have used
passages from other works, and this without full acknowledgment,
it should be remembered that after all a painter may use pigments
which someone else has manufactured, and is allowed even to employ
other persons (usually pupils) to execute certain portions of his
picture. Indeed, even after his decease, it is not improper that some
may have been entrusted with the delicate task of touching up faded
portions of the canvas which he bequeathed.

I B

2 THE CANON OF MEDICINE

The place for Avicenna in modern thought is gained when it is
agreed that he shall be viewed as one who entered this world entrusted
with a ■mission independently to express for that age, by means of
those various tools which he then found in it, the wisdom which is
unchanging and impersonal. So also there is the need to-day that
this same wisdom should be re-expressed for this age by means of the
new data which lie to our hands.

The Intellectual Culture Contemporary
with Avicenna •

§ 2. (a) Intellectual Culture in the Central Saracen Empire.
Carra de Vaux, in his monograph " Avicenne," 13 furnishes particu-
larly striking comments, as follows (p. 156) : —

" The more we investigate the enormous literary output of the
Arabian empire, and come into intimate appreciation of the master
minds of the middle epoch and of antiquity, the more we become
aware of their sincerity.

" We should, we think, offer our salutations to these great
personalities of that day, whose works and lives were equally
encyclopaedic. ...

" Our own times do not show more worthy figures ; we com-
placently assume that there are no more worthy than ourselves
because science, so greatly developed to-day, cannot be held all
within one single head. That may be. But it is only right to admit
that science has less unity and harmony to-day than formerly it had ;
that it is less pure than it was under the grand peripatetic discipline.
Our attitude towards that is neither humble nor sincere.

" In these days we are concerned too much to have our name
blazoned forth than to grasp a great extent of science. We are
more anxious to uphold the profession than to have a passion for
study ; we seek titles and reputation rather than real knowledge ;
and in order to appear more specialistic than our ancestors we expose
ourselves to the judgment of posterity as having smaller minds,
and fettered souls."

§ 3. (b) As to the state of civilization in the western Saracen
empire, we have the very illuminating description of Ameer Ali in
his " The Spirit of Islam " 2 (p. 392) : —

" The Arabs covered the countries where they settled with
networks of canals. To Spain they gave the system of irrigation by
flood-gates, wheels and pumps. Whole tracts of land which now lie
waste and barren were covered with olive groves, and the environs
of Seville alone, under Moslem rule, contained several thousand oil-
factories. They introduced the staple products, rice, sugar, cotton,
and nearly all the fine garden and orchard fruits, together with many
less important plants, like ginger, saffron, myrrh, etc. They opened
up the mines of copper, sulphur, mercury, and iron. They
established the culture of silk, the manufacture of paper and other

THE CANON OF MEDICINE 3

textile fabrics ; of porcelain, earthenware, iron, steel, leather. The
tapestries of Cordova, the woollen stuffs of Myrcia, the silks of
Granada, Almena, and Seville, the steel and gold work of Toledo,
the paper of Salibah, were sought all over the world. The ports of
Malaga, Carthage, Barcelona and Cadiz were vast commercial
emporia for export and import. In the days of their prosperity, the
Spanish Arabs maintained a merchant navy of more than a thousand
„ r !Pf- The y had fact ories and representatives on the Danube.
With Constantinople they maintained a great trade which ramified
from the Black Sea, and the eastern shores of the Mediterranean, into
the interior of Asia, and reached the ports of India and China, and
extended along the African coast as far as Madagascar.

In the midst of the tenth century, when Europe was about in
the same condition that Caffraria is now, enlightened Moors, like
Abul Cassem, were writing treatises on the principles of trade and
commerce In order to supply an incentive to commercial enterprise,
and to further the impulse to travel, geographical registers, gazetteers
and itineraries were published under the authority of Government
containing minute descriptions of the places to which they related,
with particulars of the routes and other necessary matters. Travellers
like Ibn Batuta visited foreign lands in quest of information, and
wrote voluminous works on the people of those countries, on their
fauna and flora, their mineral products, their climate and physical
features with astonishing perspicacity and keenness of observation.
The love of learning and arts was by no means confined to one
sex. The culture and education of the women proceeded on parallel
lines with that of the men, and women were as keen in the pursuit of
literature and as devoted to science as men. They had their own
colleges (for instance, at Cairo, established in 684 A.M. by the daughter
of the Mameluke Sultan Malik Taher) ; they studied medicine and
jurisprudence, lectured on rhetoric, ethics, and belles-lettres and
participated with the stronger sex in the glories of a splendid
civilization. The wives and daughters of magnates and sovereigns
spent their substance m founding colleges and endowing universities
in establishing hospitals for the sick, refuges for the homeless, the
orphan and the widow."

§4- .0) Cordova, the most celebrated western university of
the Empire at the time of Avicenna.— This is well known as an
instance of ^ the high degree of culture of the day. Ameer Ali, 2
speaks of that wonderful kingdom of Cordova, which was the
marvel of the middle ages, and which when all Europe was plunged
m barbaric ignorance and strife alone held the torch of learning
and civilization bright and shining before the western world."
1 he greatness of the city is indicated by its population, which is given
by Haeser 26 (1. 662) as 300,000, and by Campbell 12 (p. 57) as one
million ; and by the library of " about 200,000 " volumes. To see
the city to-day, traversed as it can be from wall to wall, within half
an hour on foot, and to read of an extent of " 24 miles one way, and
six m the other " (Ameer Ali\ p. 517) shows that the word " king-
dom conveys a truer idea of its greatness. To read of " innumer-

4 THE CANON OF MEDICINE

able libraries, 3,800' mosques, 60,000 palaces and mansions, 200,000
houses inhabited by the common people, 700 baths, 80,000 shops,
besides hostels and serais " is to wonder how so much can have come
to be now represented by so little.* Nevertheless the grand
mosque" alone, which is still at any rate externally intact (and
interiorly is still surely one of the wonders of the world despite its
mutilation) stands sponsor for the rest ; and no doubt many ot
the existing imposing buildings— now devoted to very different
US e S -_stand for the palaces and mansions. As to the literary
treasures, these have been traced at least in part from Spain to J?ez,
as shown by Home" (p. 32, 6i), with the Roud El Qartas as his
authority ; and he then points to years of pilfering from the library
of the great mosque of El Karouiyan at Fez, as having scattered these
works for ever out of ken.

5 t A studv of the street names, and even the place names ana
current dialect in " Moorish Spain " to-day also confirms the story
of past greatness. But the mystical knowledge displayed in the
dispositions of the decorative designs and their poetic inscriptions
on the walls of the Alhambra halls, state-rooms, and private
apartments can leave no doubt of unsurpassed artistic power, where
every sense-impression was deliberately drawn on. Lights and
shadows, and colours changing with the hours of the day ; musical
effects of simultaneous diversity of disposition of flowing water
perfumes ; courting of the prevailing breezes ; interior architectural
form ; and furnishings, animate and manufactured— all these were
combined for the achievement of a perfect representation of (divine,
over and above human) Beauty.

8 6. (d) Among the Chinese. The bearing of Chinese philoso-
phical thought on the subject of Avicenna lies in the fact that we here
meet with a notable example of intimacy of relation between world-
conception and Medicine. The writings which are so carefully
studied to-day by so many sinologists were extant at the time ot
Avicenna, and are still held in the highest esteem by Chinese thinkers.
The modern Chinese philosopher is supposed to say to the Westerner
(Somerset Maugham 54 ): " What is the reason for which you deem
yourselves our betters ? Have you excelled us in arts or letters ?
Have our thinkers been less profound than yours ? Has our
civilization been less elaborate, less complicated, ess refined than
vours ? Why, when you lived in caves and clothed yourselves with
skins, 'we were a cultured people. ..." The attitude towards
western learning so displayed may be blamed by many bu. is
certainly praised by those who have studied the philosophy most
deeply. As long ago as 1876 we read conclusive evidence (by Sir
Henry Howarth 35 ) that much of our vaunted civilization actually
came from that ancient race. If some students discuss their
philosophy with a certain cynicism (Forke 23 ),_ others (Bruce ^
Wilhelm 101 ) see into the justice of their conceptions. As Uarus
remarks : "We need not be blind to the many errors and absurdities

* " Every dwelling-place, even if it has been blessed ever so long, will one
day become a prey."— (Old saying quoted by Ameer Ah, 1 p. 125.)

THE CANON OF MEDICINE 5

of the ancient occultism to understand and grant the truth that
underlies its system." These words are exactly applicable to the
Canon of Medicine of Avicenna.

It should be added that errors and absurdities are apt to be ascribed to ancient
authors which really arose from misunderstandings and ignorance on the part
even of contemporary pupils. The subsequent generations perpetuated the errors
and even m these days the attempt to represent the real meaning of ancient texts
by translations exposes one to unexpected extraordinary pitfalls. Our idiom is
so diverse from the technical Chinese.

The Nature of the Knowledge Presented
by the Canon

§ 7- (a) The Canon is a precis, and not a sum-total of Avicenna's
knowledge. Numerous passages occur in the Canon which show
that this is the case, that it is a series of notes or skeleton outlines of
thought not too lengthy to be memorized by his students (5)— much
as they would memorize the Quran. Thus : (2) " to the full extent
necessary, and yet with apt brevity," (16) *' do not place in medicine
what does not belong to it," (34) " having discussed the equable
temperaments sufficiently," (80) " I purposely omit reference to
certain other problems relative to the fluids of the body " : '* just as
much as is necessary to enable you to practise medicine intelligently "
Many passages also refer to others of his own works for further
details to avoid confusing the purely medical issue of the Canon
Ihese (philosophical) works are gradually becoming more widely
known. J

" Generally speaking, the saying of the saints and sages are
terse, presenting only the germs of truth ; these are developed by
later teachers and then expanded and added to. We must see
to it, however, that we get at the original meaning of the saints
and sages." (Chu Hsi 10 , p. 168.)

™ + •" ^°° k ^^ ar ! ?? ly T° rds ' and the valu able part of words is the thought therein
C °fSf d - .J 1 "* bought has a ce rtain bias, which cannot be conveyed in words
yet the world values words as being the essence of books. But though the world
values them, they are not of value ; as that sense in which the world values Them
13 no \^ e **** "^h they. are valuable." (Chuang T Z u, Giles trans I. i 7 o?

,-= „„ ! i To 3ay a W °I k 1S the P roduct ° f tte age in which an author lives'

s certainly often an error, for it is to confuse the person's insight with the tools

(the language at his command) available to express himself with. Similarly to work

out the relation between a literary work and the religious belief of theauthoras

ame'fanacv wRnT " tV'p ^ ^^ ISlamlC SCienCe and the Koran carries tte
f^ e X laC y ^t* rt ; J h * Prophet says every soul when born is a faithful follower ;
it is afterwards that he becomes unfaithful "—which is to sav that the form of re^

tSf £ thl 1S a SeC ?* da ^ ^plantation, whereas the spirit 6f a sincere life^can be
traced to the original being.

= =+» Avic «ma;s medicine, like Indian medicine, has been traced to the Greek
system But it has been proved that the great works of Charaka and Susruta
were available m Arabic, under the title of Kitab-Shawshura-al-Hindi from the
seventh century (''Ayurveda," 1924, i. x ; and see also Weber, Hist ' of Indian
Lit.).— Similarly, the view that the Chinese borrowed their philosophy of the five
elements from the Turks has been sufficiently disposed of byFor^ fp ° 4 * 2 S
—It is beside the purpose of this treatise to take up such questions.

6 THE CANON OF MEDICINE

S o The common notion that progress or stagnation in secular knowledge
has alausaTrelat™hip with (a cert^a) religion is typically voiced - ^^
on " Medicine and the Church," bySir Farquhar Buzzard" 3 (1927 ■ ine comment
to make is ''toft loosed nan propter hoc." The advances in the science of medicine
as ki all other sciences are surely a part of the (divine) plan for mankind ; whereas
?L col ateral abandonment of Religious fundamentals remains a human respon-

sibilitv.

8 10 (6) The word " Canon" (Qanun).— Equivalent words:
code of laws ; series of principles. Tao ^ (cf. Forke 2 *). Prin-
ciple is defined as "something antecedent, which exercises a real
positive influence upon the consequent " = Causes (four kinds, 13)-

Reasons. _ . 1 . u~

In view of this it is clear that the Canon is not properly to be
regarded as an " encyclopaedia " of the knowledge of the time, or
to be contrasted, for instance, with the now classical Osier. _

811 U) The word " knowledge." Knowledge is not simply
an assemblage of " facts " ; nor is it to be made synonymous with
« truth "—certainly not Absolute Truth, of which all human
knowledge falls short (see diagram in Appendix), although one single
word is capable of containing or implying all knowledge, as in
mathematics a single term may be equated with an infinite number ot
terms summed together. But even the mathematical sciences can
only afford approximate truth (Hume, quoted by Maher 50 : p. 238).
We may recall the words, " if he attain to all knowledge, he is far
off still" (a Kempis 95 , ii. n).

S 12. Facts, as S. Thomas 81 , (1. S3) explains, are what our
intellect regards external objects as, and as we judge of them only
in terms of our sense-organs, these objects may be different. God
knows them as they are. Our intellect depends on our imagination,
and that depends on our senses, and our senses only convey discrete
fragments which we gather into one continuous impression regardless
of intervening points." We live as it were in a network only the
nodes of which are evident to the senses. _

S 1 *. (d) Mystical Insight.— There is a distinction between
knowledge gained in the ordinary manner and that gained by
"mystical insight" {Kashf). The writer of Gulshan-i-Raz^ (couplet
299, p. 30) advises his readers to follow this, saying :

And

" Straightway lift yourself above time and space, ^

Quit the world and be yourself a world for yourselt.

" The moment we are enlightened within,
We go beyond the voidness of a world confronting us

s y —Seng-ts'an, quoted by Susuki," p. i8>

As this " opens up all of a sudden a world hitherto undreamed of it
is an abrupt and discrete leaping from one plane of thought to
another" (ib. p. 200).

" Real science is seeing the fire directly,
Not mere talk, inferring the fire from the smoke.
Your scientific proofs are more offensive to the wise
Than the urine and breath whence a physician inters.

—(p. 306.)

THE CANON OF MEDICINE 7

" Man looks at the -surface of the ocean. Yet he is so small that he cannot
even be compared to one of its drops, limited as he is in intellect and in his know-
ledge. It is only to those who, having just touched creation, bow to God forgetting
their limited self, that God has remained. These through whom God has spoken
are the only beings who have been able to give any truth to the world." 33 — (Rose-

anvrlun, ISt ed., 120.)

§ 14. " The mind is not like a horizontal door which has to be
made larger by force. You must clear away the obstructions arising
from creaturely desire, and then it will be pure and clear with no
limit to its knowledge. Heng Ch'u said : " When the Mind is
enlarged it can enter into everything throughout the universe "
Chu Hsi 10 (i. 182). " He who praises God knows about Him."

This attitude towards Nature is to be claimed for Avicenna, on
the plain evidence of his other writings, including the " Al Naj'at "
which appropriately appears in the Arabic version of the Canon
printed at Rome in 1593, and of the Libellus on the powers of the
heart 4 (real authorship disputed) which Arnold of Villanova trans-
lated into Latin (ca. 1235-13 12) — arfff is included in the Latin
edition of the Canon, 1595.

The acquisition of knowledge by this process demands nothing
more than a keen observation of the life around us, and was as much
within his reach as ours. Such knowledge is not too restricted to
one period of history, one language, or to one or two universities.
And if it should seem that because our civilization is so different
his opportunities were much less, we may pause to reflect that the
difference between our age and his is chiefly one of mechanical
appurtenances and phraseology ; and that even to this day we need
not travel far (e.g., the old streets of Cordova and Granada, or more
definitely, to northern Africa) to see much the same sort of scenery
as he wasaccustomed to, much the same sort of life as is drawn in the
" 1001 Nights." In any case, what is human life, at bottom, but a
matter _ of buying and selling, receiving and giving, seizing and
relinquishing, constructing and demolishing, acquiring learning and
losing it,_ seeking power and breaking it, bidding and forbidding,
covenanting and comminating, giving in marriage and seeking to
obtain in marriage, birth and death.

§ 15. The significant phrase "seeing into one's own Nature" (Hui-neng •
busuki," p. 203, m which most admirable work occur many passages by way of
explanation) gives a graphic description of that which gives Avicenna his superiority
lhe Canon is simply the medical garb in which the one Truth is expounded. It is

for us also to perceive it in whatever idiom it might be described Western

Eastern — Islamic, Confucian or Buddhist, e.g.

It would then seem as if the mind were now able to float as it were round 'all
the concepts man has ever given to the world, or round all the most familiar events
of one s daily life, and perceive clearly that which can never be set forth in words
We should then also quote the words (given in ib., p. 223, in reference to satori—
enlightenment) I perceive of it that it is something, but what it is I cannot per-
ceive. Only meseems that, could I conceive it, I should comprehend all truth."

§ 16. Further than this, to find that some of the statements in
the Canon are certainly erroneous, and that modern investigations
have placed us at an infinitely greater advantage, does not invalidate
the work as a whole. Its possibilities for suggesting thoughts of
real value to-day are more realized the more one reads " between
the lines," and the present treatise does not claim to exhaust them.

8 THE CANON OF MEDICINE

" Let not the authority of the writer offend thee whether he be
of title or great learning, but-let the love or pure truth entice thee to

read " (a Kempis 95 , i. 5)-

„ t • -K+- ,-n+n eternal truths —A person may (a) glimpse them, (6) under-

♦ H § tnL modlStely (?)TrSeSS then? fairly thoroughly. But m describing

denied bv persons being told of them, tor because in urcu iuiu y

capacities of the higher.

Ill

The Basic Difference Between " The Canon "
and Modern Medicine

The Canon treats of

I. Speculative " Medicine."
Certain fundamental principles
(Cosmology, psychology, meta-
physics)

II. Practical Medicine. .

A. Application of I to the study
of (i) health, (ii) disease (ten-
dency, predisposition, threshold
stage, declared disease, (iii) ces-
sation of life.

Modern Medicine consists of

B. Actual treatment of " disease "
by (i) regimen, (ii) drugs, (iii)
operative interference.

A. Principles of Medicine
Theory : The application of the
facts of chemistry, physics,
anatomy, biology to the sys-
tematic description of innumer-
able " diseases " classified as
far as possible on the basis of
the microbic theory.
Symptomatology. Etiology.
Diagnosis.

B. Practice of Medicine..

(a) Laboratory work.

(b) Therapeutics, pharmacol-
ogy and dietetics.

(d) Gynaecology and Obstetrics.

(e) State Medicine : Hygiene
in all its branches.

(/) Psychological Medicine:

Treatment of insanity.
(g) Legal medicine,' etc.

THE CANON OF MEDICINE 9

Modern medicine is based on the conception of the universe as
a conglomeration of dead matter out of which, by some unexplainable
process, life may become evolved in forms. To Avicenna the whole
of the universe is the manifestation of a universal principle of life,
acting through the instrumentality of forms. Or, again, in modern
medicine, the forms are the source of life ; to Avicenna they are the
product of life. Space itself is an aspect of the one life (Hartmann,
on Paracelsus, 28 a, p. 217).

§ 19. In this way the difference between Avicenna's conception
of " principles," and that of modern medicine is easily shown. To
the school-boy " science " would consist of (a) " bookwork,"
(0) laboratory work, which his teachers would insist is the basis of (a).
Similarly, the medical curriculum begins with lectures, though these
are more and more inclined to become laboratory demonstrations ;
and goes on to laboratory and hospital work.

§ 20. In short, Avicenna's medicine, and all ancient medicine, is
intimately bound up with philosophy, to wit, that of human nature —
a philosophy which proves to be virtually identical with " modern
scholastic philosophy," no doubt partly because the Quranic account
of the origin of Man tallies with the Christian.

§ 21. Modern Medicine, on the other hand, assuming the title
and rank of a positive science, emphatically discards and excludes
it. Hence we read : " the physiologist " (said Burdon Sanderson)
" can pursue philosophy if he has a turn for it, but must understand
that the moment he enters the field of philosophy he leaves his tools
behind him " ; or " it is unfortunate that the limitations of scientific
thought were often ignored by men of science in their writings . . .
the result diverts those who know, but befogs the unsuspicious
reader who will probably put the blame on his intelligence " (Ed.
Hughes 36 ).

" According to Positivism, science cannot be as Aristotle
conceived it, the knowledge of things through their ultimate causes,
since material and formal causes are unknowable, final causes (are)
illusions, and efficient causes (are) simply invariable antecedents,
while metaphysics under any form is illegitimate " (Sauvage, 17 , xii.
313). Or, expressed more boldly, " philosophy " is considered to be
the exact antithesis of the truth which modern medicine gives us,
and is therefore inherently inadmissible to medicine.

The ignorance which accounts for this attitude is only met by
insisting on proper definitions of terms. The following apply here :
Philosophy is " the science which is concerned with first causes and
principles ; it is the profound knowledge of the universal order, and
the duties which that order imposes on man (Mercier, Logique,
1904; de Wulf 17 : xii. 26). Again, philosophy is the true perception
and understanding of cause and effect. — Metaphysics is " that
portion of philosophy which treats of the most general and funda-
mental principles underlying all reality and all knowledge " (Maher 56 ,
p. 520). — Psychology is " the science which treats of the soul and its
operations " — rand, therefore, clearly, must be the real foundation of
Medicine.

THE CANON OF MEDICINE

8 22 It is in modern scholastic philosophy that the student
finds ample exposure of the fallacy in positivism and its cognates
enabling him to detect the difference between false and true, expressed
with enough force of logic to satisfy the most meticulous This
queen of all the sciences amply proves positivist science (including
Medicine) to be incomplete knowledge when taken alone, ifte
knowledge of movement or change must be supplemented by
mathematical and metaphysical view-points. (Cf. Merciei ■» pp
,q 36; and especially Wundt 17 : xu. et 35). Such men as Albertus
Magnus and Roger Bacon were convinced of the necessity of linking
the sciences with philosophy 17 (xii. 38). rMr u Pa

When medicine has in this way become ennobled it reaches
its highest degree of perfection, in that it penetrates to the very
depths of reality 56 (p. 9), admitting this knowledge to need even
then, a further complement to make it complete— namely, knowledge
in relation to God (" Christian wisdom ")•

" Sapientia est scientia qua considerat ^f^f^^T" E
Sapientia causas primas omnium causarum considerat (In- Met I ;^ t s 2 . ^
cofnoscit causam altissimam simphciter, qua est Deus ^ci^r sapiens ampL^ter
in miantnm ner regulas divinas omnia potest judicare et ordmare (bum. ineoi.
TT I a £ art if) " Non acquiritur studio humano, sed est deursum scendens
Ubid' V) "Cum homo per res creatas Deum cognoscit, magis videtur hoc
Stinere ad scientiam ad quam pertinet formaliter, quam ad sapientiam ad quam
?ert nef materianter et e converso cum secundum res divinas judicamus de rebus
Create nTagis hoc ad sapientiam quam ad scientiam pertinet (,&. q. 9, a. 2, ad 3).

As St. Thomas 81 said in his day, " they think that nothing exists
besides visible creatures " (C.G., ii. 3, 1-P- 5)[N.B- Creatures
are (a) animate, (*) inanimate] ; " they think that things P«>ceed not
by the divine will but by natural necessity " (ib.). So even m those
days time and fortune were expended on researches which sound
philosophy would have shown to be inherently futile.

We mav reflect for instance on the reiterated search for a location of the soul,
which tLpToneer C anatomists prosecuted, and also on the commonly repeated
Innouncement to successive students of anatomy that the pineal gland is now no
lonTer^egarded as the site of the soul. There is the sub-conscious suggestion to the
stafent that scientific research has effectively disposed of the medieval behef m
S soul, whereas history only proves that the revolt against the precise te a chmgs
„ f +nP Council of Trent 16 d S45-1563 necessarily came to naught. J. he ver> aenni
• tion of 9 ' soul '■ whichlhis council laid down makes a search for its location ludicrous.

Special Differences between the Canon and Modern

Medicine

A. Conceptions known to Avicenna ; not now recognized.

823 There are four main conceptions belonging to the Canon,
but not recognized by modern Medicine. To use S Thomas
words 83 84 (i. 32 ; art. I ; p. 270) they can be shown to be not
impossible " ; that is, the discoveries of modern science do not
abrogate them.

THE CANON OF MEDICINE i r

These conceptions are relative to (a) the nature of the human
being as a whole, (b) the constitution, (c) the " breath," (d) the
" elements." Each of these is dealt with in some detail under the
corresponding sections of the Canon, but some of the salient points
are suitably referred to at this stage.

§ 24. (a) The conception of the nature of the human being as a
whole. — The varieties of views on this point which people in every
country and race exhibit both in conversation and in literature,
numerous though they are, are capable of classification under one of
three headings :

(i) The first — the Platonic view — regards the human being
as " soul within a body," while admitting " soul " to be indefinable,
and beyond the power of location. This view, widely supposed to be
" Christian," is well known as " pagan " to students of folklore.

(ii) The second — the scientific or rationalistic and modern view-
takes the physical body as the fundamental, seeing in it the outcome
of known or at least knowable forces. The facts of anatomy,
physiology, etc., convey their own inevitable conclusions. This
view makes its immediate appeal. From the first lesson the pupil
is able to feel a grasp of some tangible knowledge, whereas the
alternative third view entails a long study before the intricacies of
abstract philosophy can be mastered. The difference between
experience and •" poring over books " is only too obvious. The
possibility of interweaving the two methods is not on the horizon.

In its answer to " religion," this scientific view has no objection to raise to
its votaries retaining a private belief in the Platonic view, if their temperament
demands it. But this " pious belief " must not be allowed to vitiate procedure
when scientific research is undertaken.

This modern conception regards the body as an aggregate of
" spare parts " which are " assembled " well, or ill ; can be repaired,
or remedied. According as the assembling is good or bad, and
according to the " fuel," so is there health, or susceptibility to
infection by organisms. The kind of assembling is a matter partly
heredity and partly of environment.

The following remarks in a review on a recent article in Science — by Lillie—
may be quoted from the Times, Oct. 24th, 1927, p. 19. They present the idea in
technical language : —

"Physiology finds the organism to be a nexus of physicochemical determina-
tion ; differing only from non-living systems in its complexity. . . . Speaking of
freewill, one argument against ' indeterminism ' is that ' the energy balance sheet
of a man shows us there is no creation of energy within the bodv ' To assume
will-power ' we conflict with Newton's first law.' . . . The ultraniicroscope alone
suggests indeterminism, and even this may be only because we do not know enough
about Browman movement, etc. Protoplasm is a ' heterogeneous system ' In
heredity submicroscopical units determine the details of inheritance— but an event
originating in an ultramicroscopic particle can spread to the whole cell or organism
On this view, a human action appearing entirely spontaneous and voluntary to the
actor and spectator would exhibit itself as- a succession of mechanically determined
events capable of study and prediction in all its microscopic details But traced
inwards it would ultimately resolve itself into certain ultramicroscopic events in
the interior of the nerve-cell." But *' even the freedom of the ultramicroscopic
particle may be no more than a subtler kind of determinism beyond the reach of
present analysis. §64 contradicts these remarks.

It may be noted, in passing, that the doctrine of vitalism is really only another
form of rationalism, as will appear when the scholastic doctrine is duly investigated

THE CANON OF MEDICINE

S25 The third view— scholastic, Thomistic— presented by
modern scholastic philosophy, has the Aristotelian basis, its
soundness is best appreciated by careful study prolonged until the pre-
valent inadequate and illogical conceptions of the universe are clearly
exposed Briefly, the view is expressed in the words : the human
being is a material body vivified by a life-principle, the two together
constituting the rational human soul." As S. Thomas "says : It is
not my soul that thinks, or my body that eats, but I that do both
fp zO. In other words, again : The body and soul form one
complete whole-one "single being ^ (p. S3); 56 (P-.302, 306).

It is this view which underlies the whole Canon, and is expounded
in connection with the corresponding parts of the text.^ It is this
vie w that makes the ancient work fal 1 in line with the most modern
Its consequences are far-reaching. The external configuration of the
body, including the physiognomy, is a reflection of the functional
capacity of the internal organs and general make-up of the individual.
The character, talents, physical form, shape of individual features
general development, and indeed every detail of the physique, length
of limbs, of fingers, cutaneous markings, contour of the eyes and
ears, etc, are all part and parcel with the functional conformations
of the viscera, and the mental characters ; a study of the -visible will
inform of the nature of the internal conformation. (Ci. 107)

8 26 The idea that from a study of external features and general habit one
should deduce conclusions as to functional capacities* is generally opposed by
academic Medicine ; as is voiced by F. v. Muller 1921, quoted by Kolle, Mitt.
Ggeb Tied 1926 40, 371) when he says " we must steadfastly avoid drawing any
fell-reaching conclusions about the functional behaviour of the organism from a
studv of the external characters of the body." .

7 While it may be urged that the external features are usually misread, it may
also be admitted that even the customary " physical examination of a Patent
does not vield uniform results when practised, as it neces sari yis by P™so f
varying talent. Surely, the remedy is to exert greater care, ^e may for instance
observl how a skilled weaver will detect the site of a flaw ^ the set-up of a
loom by a mere glance, whereas a novice discovers it only after laborious search.

866 § On the other hand, the biochemical tests for functional capacity of organs—
so much the vogue, and so much exploited, and so duly impressive on patients
and their friendf-are clearly inadequate in the light of the scholastic doctrine,
ft is true that the attempt to force the intangible to yield to mathematical formute
rules, and weights and measures (as, for instance, in blood-cholesterol analyses)
is sincere enough, to judge by the time, energy and money expended so freely
But what is to be' the verdict once it is realized that the anatomical organs are , not
functionally discrete or amenable to distinctive specific tests ? A u ^ appreci
ation of the intimacy of relation inherent in the conception of the human being
ins°sted on here suffices to show the futility of those labours and studies whether
made upon man or upon the various orders of animals taken instead.

More than this, there is the conception that the internal organs
belong to one another beyond the anatomical limits. The heart, to
anatomy, is a circumscribed organ ; to Avicenna it is part of a force
occupying the whole body. " Man's heart is both corporeal and
incorporeal " (Chu Hsi 10 , i. p. 162). So, again, the liver is simply
;a visible portion of a " liver " whose operation pervades the whole

* The relation between character and physique was scientifically studied by
the Chinese 450 B.C. (Cf. Wieger.)

THE CANON OF MEDICINE i 3

body.* Or, to combine modern with ancient knowledge, the physical
heart, the arterial vessels, and the sympathetic nervous system,
including the connections between this and the sensorium and that
which corresponds to the " sensitive soul " in its emotional aspect,
for instance — all this is one great composite ; and its state is also
reflected in many subtle indications which offer themselves to the keen
observer of the patient.

The modern research on diseases of the brain and insanity is based on the
assumption that the material brain is the source of all nervous activities, which
are correlated with definite biochemical, physicochemical and even structural
changes in brain substance. Mental disease is the outcome of similar changes.
The Platonists would consider mental disease as apart from the " soul." The
Thomistic view leads to much more subtle conclusions, capable of lasting influence.

(jy) The doctrine of " the constitution."

§ 27. The term " constitution " conveys different ideas to
different minds. The laity regard the term as synonymous with
" temperament " or " make-up," at least in part, and consider a
description of a patient as having a nervous temperament, a delicate
constitution, etc., quite adequate. With this goes the conviction
among the lay that the medical curriculum leaves the graduate fully
able to " understand his constitution " whereas in actual fact the
subject is never discussed. The study of physique is quite superficial,
and is admittedly made solely to establish a diagnosis of specific
" diseases." Hence the term, in conversation, is actually nothing
more than platitudes.

To modern medicine, regarding the body as corporeal, constitu-
tion is a matter of physique, resistance to disease, mode of reaction
to various stimuli (including psychic stimuli). Classifications of
varieties of constitution on this basis are afforded by various writers
in all countries — e.g., a classification into athletic, leptosomic and
dysplastic ; into arthritic, endocrine, lymphatic, asthenic, infantilistic,
chlorotic, etc. (Current medical journals).

In the Canon, Avicenna establishes " constitution " in terms of
humours, temperaments (hot, cold, dry, moist) and " elements "
(whose proportions are set for every individual. — 47). If we go
further, and apply to this term the method which Rumi 37 (p. 169), the
great Persian sage demanded of students of the Quran, we shall not
regard a patient's constitution as understood until we have studied
the matter much more intimately.

" Know the words of the Koran are simple,
But within the outward sense is an inner secret one.
Beneath that secret meaning is a third,
Whereat the highest wit is dumbfounded.
The fourth meaning has been seen by none
Save God, the Incomparable and All-sufficient.
Thus they go on, even to seven meanings, one by one,
According to the saying of the Prophet, without doubt."

* Cf. Paracelsus, de viribus membrorum (Hartmann, p. 219). Moreover,

each individual " is a member of the great organism of the world " . . . " not
a separate being isolated from Nature." (lb. p. 51). Individual: human world :
one leucocyte : one human being.

I4 THE CANON OF MEDICINE

" I know," said Tawaddud, the lady most learned, " the sublime
Koran by heart and have read it according to the seven, the ten,
and the fourteen modes " (438th Arabian night). _

Therefore to draw a lesson for our study out of these indications,
we shall see that the aim in view is to formulate a person's constitu-
tion out of a number of components, none of which must be omitted
from the series . To- express the whole picture many modern aspects
must be studied— histological, biochemical, psychological^ without
neglecting factors (metaphysical, etc.) accepted by the ancients but
almost forgotten to-day. For instance, the past events in the
ancestral history of the patient must be included, and all the factors
coming into play even from the time of quickening may not be over-

°° The insight afforded by the true conception of the nature of the
human being in this way leads us on to an understanding ol
individual constitutions which should be amply satisfactory.

(/) The doctrine of " the breath."

8 28 This subject is discussed in the course of the text (§ 136).
The term " breath " found in Eastern writings is taken as the exact
equivalent of Avicenna's conception, and is understood properly
only when the " elements " are understood (see §^73).

Equivalent terms : life-principle ; hayat ; Sj-=- ; the breath
of life; virtus vitalis ; spiritus ;- vitality ; Hu (in Persian mys-
ticism*) • Ch'i M, J nafas ( also used for sou1, individuality ).

It may be conceded that many of these words are used
synonymously with much confusion in consequence. Thus the old
doctrine of vitalism, supported by vitalists, is not the antithesis of,
but strictly speaking, another form of rationalism. In Paracelsus
we read " the first matter of the elements is nothing else than lite. . ._ .
The soul of the elements is the life of all created things. . . . There is
aeain a difference between the soul and the life. Fire _ if it lives
burns But if it be in its soul, that is, in its element, it lacks all
power of burning " (Opera ii. 264). Errors of this kind are avoided
by a careful study of the scholastic philosophy.

(d) The doctrine of " the elements."

§ 29. This is fully entered into at the end of the corresponding chapter in
the transia ^ « j*"^ universe in terms of four , or five , elements has been
found among alf peoples. To argue in favour of the doctrine almost compels an
attempt at harmomlation of its different forms (Aristotelian, Indian, Persian,
ChS for S • Suppose a number of people each set out to paint one certain
landscape^ that each is of different nationality ; that each is restricted to a certain
limited number of pigments ; that each is a true artist. The final picture presented
bv each wiU be striking and inspiring. But it would be out of place to begin and com-
Sre stick with stick fnd stone with stone. If we understand, we shall learn-from
each Th™dern futurist may excite ridicule in his attempts to depict a landscape
jn terms rf^ychic forces, which he claims to discern, but to the mind of a student

* Hu in Chinese, p£, is not the exact equivalent, through being used more
for the act 'of expiration— unless there is a mystical sense attached to the term.

THE CANON OF MEDICINE 1S

his work would have a 'different effect. These varying forms of one conception
are amenable to intelligent understanding. (Cf. note to 20.)

§ 30. Carus 15 (p. 34) writes : :." An explanation of the universe which derives
all distinctions between things, conditions, relations, etc., from differences of mixture
must have appeared very plausible to the ancient sages . . . even to-day Western
scientists of reputation attempt to explain the universe as a congeries of force-
centres, acting either by attraction or repulsion in analogy to positive and negative
electricity. On the ground of this fact the educated Chinese insist with more than
a mere semblance of truth that the underlying idea of the Chinese world-conception
is fully borne out and justified by the results of Western science." Elsewhere the
intimacy, in fact unity, between this philosophy and everyday life (Forke 23 pp
239, 269) is referred to as the justification for so often quoting Chinese thought in
expounding Avicenna.

B. Conceptions known to modern medicine ; but not to Avicenna.
§ 31. Among the most important of these are :

(a) the anatomy of the circulation of the blood, (b) the rate of
that circulation, (c) The details found in Quain's anatomy ; the
microscopic anatomy ; such complexities as form the theme of
Bayliss' Physiology. These details might be expressed as those of
" the _ mechanics of the body." (d) Interactions in the tissues:
chemical and cellular metabolism, (e) In pathology — the microbic
theory ; the endless and always increasing number of " diseases "
the laboratory diagnosis of dysfunction of organs ; (albuminuria was
of course, unknown) ; symptoms as evidences of disordered reflexes.
if) In treatment : the use of antisera and specific anti-substances of
organisms ; hypodermic medication ; complex drug treatment has
passed out of vogue. Surgery.

§ 32. Considerations which suggest that these instances of
ignorance are not as grave as is supposed, and do not invalidate the
standing of ancient medicine in regard to actual practice :

Ad (a). Circulation of a kind was propounded in the case of
the " breath," the elements, and the body-fluids, though not along
anatomical channels. The Chinese recognized a process of " revolu-
tion," a succession of cyclical changes, an ebb and flow. Indeed it
is suggested in Duhalde 20 (p. 184) that the Chinese knew of the
circulation of the blood itself some hundred years B.C.

Wieger (p.309, on Su-Wen), discussing whether the Chinese knew of the cir-
culation of the blood twenty centuries before Harvey or not, decides truly that
_ their knowledge of the circulation of the blood in the human microcosm was
intuitive, not experimental, conjectured in imitation of the circulation of the vital
principle m the universal microcosm, in which they believed They guessed the
fact and they never verified it. . . . During more than twenty centuries, the how
of the guessed circulation never worried their mind. The yfn-yang circulates
m a ring, the five agents do the same, the blood the same. That is all . . .*'*

Ad(b). The rapidity of the changes was certainly not realized.
The Chinese apparently believed that the circulation was completed
only fifty times in one day (there is however room for fallacious
translation).

Lest there should be over-satisfaction with ourselves, it may be suggested
that the rapidity of the movement of the lymph was not realized before about 1908,

* But if a doctrine which is common to Taoism and esotericism (that of micro-
cosm and macrocosm) is allowed to be valid, the words " intuitive knowledge '*
cannot be made synonymous with " conjecture," " guess "

l6 THE CANON OF MEDICINE

and is perhaps notfully re^^y^n Y^^^^^^^^^

« ISh'leal ^cfflScrf Sieria (c£. Arch. Exp. Med 19**33)
3S not reafed the exttence of a circulation of nerve-impulses is not yet admitted.

Ad (V> The capillaries of the liver are referred to in 83 ;
in the body in general in 85- True, what Avicenna calls capillaries,
are large?Aan those -we see with the microscope. But he knew that
the bklod passes from large trunks into the liver, traverses capil-
laries " in the liver, and re-emerges by large trunks.

Ad (d\ Interactions in the tissues were conceived of as-
taking place with an ebb and a flow (which is correct) ; lymph,
exudes into the tissue-spaces. Interactions take a considerable
tfme (true). Digestion goes on within the blood-vessels m various

P^W^Fermentation" was the counterpart of bacterial
growth as we know it. The term is used ^^P^^ 1 ^
text r e ex 78 79). Diseases were regarded chiefly as parts oi a
pTLssflnd there were but few processes (which ^ quite ^
nine processes : see § 172). Urinalysis was carried out in order to
assess the functional state of the liver (605). Qlin prioritv

S « Ad (f). Modern medicine claims its title to superiority
bv its successes and judges the medicine of the past by its failures. ■
B'ut whaTwouid the J judgment be if this method were reverse^
Suppose we accepted the verdict of those among the laity— not so tew
-who are dissatisfied with their experiences of orthodox medicine
and have turned to the " unqualified " of one kind or another ? or
tTot^Totecountries who prefer their native doctors st i 1 or even
those Europeans who have experienced triumphant success from
native doctors, after modern methods had failed ? After all the
ancient medicine is still practised from Cairo to Calcutta and a
medicine not very different holds sway through the Far East ihe
Ste Sir Charles Pardy Lukis (Ind. Med. Services) is quoted as
sayine '' Many of the empirical methods of treatment adopted by
hakims are of the greatest value, and there is no doubt whatever
thatTheir ancestors, ages ago, knew many things which are nowadays
beine brought forward as new discoveries (Ayurveda, 1924, 2, 1. i>

g Drug-t g reatment.-The complexity of P™™f™**™%
times has -iven place to simple and short ones, and the tendency is
to dTscard them altogether. But the reasons for the ancient method
are given in the Canon, and Avicenna s &°™ ?!* m ^^^
on a careful consideration of the constitution , of ^^^^
as' of the patient and his idiosyncrasies. Thus, certain ingredients
wol Kwed o r disallowed in a given ^*™^ e
according to the nature of the particular P atlent k ™f Jf"^??
or absence, and the amount, of nardus, ginger, fennel-seed, anise,

• misaddress, ■■ ^^^^^^i'^^T^^l^^

" modest standpoint " can surely hardly be saxd to be really G enerai

THE CANON OF MEDICINE 17

piper, cyperus rotundus, must be according to the season, and the
age of the patient " 89 (p. 91). ,

§ 34. Hartmann 28 (Chinesische Heilmethoden, Munch, Med.
Woch., 1927, June 3rd, 935) describes the accuracy of native
diagnosis (from the pulse, §204) as "disconcerting,"* and describes
certain forms of treatment (auto-chemotherapy, Bier treatment) as
being practised in a manner only different in outward appearance
from the technique which we pride ourselves as being absolutely the
" latest." " No wonder," he says, " that the Chinese are proud of
their art, considering how long they have known that which we have
only recently discovered. "f

§ 35. The cynical mind cannot be upheld which passes off the
reputed successes during the Middle Ages as coincidences, and over-
looks the modern crowded out-patient departments as evidences of the
limitations of our current therapy and theory ; nor can the sceptic
be much noticed who denies miraculous cures rather than admit
scientific theories to be in any sense inadequate.

§ 36. Nevertheless, it is obvious that the principles of the Canon
could not be taught over a hospital bed or in the out-patient depart-
ment. It is true that they cannot cater for the wholesale require-
ments of the hospital or clinic. It should be clear to the candid that
our modern technique does not avail for 1 00 per cent, of cases ; for
those who do not benefit at least an experiment with other systems
of treatment should not be denied. If the fault is laid at the feet of
over-strenuous routine work, the more leisured may yet find an
advantage in a system which puts the details of a person's constitution
in all its aspects into the forefront, where there is no question of
teaching it either to classes or even to possibly indifferent individuals.
The words of Paracelsus may be recalled, where he says : " the
doctor who loves his art does not undertake twenty cases but five,
knowing that no one person can conscientiously treat more than a
certain number. No one person could ever make the whole world
sound."

C. Knowledge common to Avicenna and Modern Medicine.
§ 37. A perusal of the text of the Canon will show many
passages which apply quite well, without explanation, in these days.
Thus, the following may be specified : the close relation between
emotions and physiological states (shown to be even closer than
modern research has realized)/ — The classification of people into
sanguine, phlegmatic, bilious, saturnine, frigid, "hot." — The
physiology of sleep, and how posture may remedy insomnia. —

* The same wonder at their practice is recorded in a.d. 1253, when the friar
William of Rubuck visited their country.

\ These words can be fully endorsed, if only from a study of the Chinese classic
on the pulse 98 (80 volumes), discussed under the heading of " The Pulse " in the
present treatise (§ 208). Among other ancient Chinese medical works (first seen by
the present writer in the very extensive collection in the Library of M'Gill University,
Montreal) reference may be made to the astonishing accuracy of representations
of medicinal and other plants, and the almost dramatic representations of various
diseased states in the i" tsung chin ch'un by Hung Chou — extant in Avicenna's time.
This work was reprinted between 1904 and 1924, and an older edition is in the
Library of the School of Oriental Studies (London Institution).

l8 THE CANON OF MEDICINE

Choice of location for dwellings. -The choice of a good drinking-
water.-Health resorts. Climatic influences on health and dlness
Plethoric maladies.-Dietetics.-Hydrotherap.-^egimmal reat
ment— The uses of counter-irritation.— Bier treatment.— i he intro
Action of remedies into the urethra.-The use o vagina 1 tampans -
The use of anaesthetics by the mouth (medicated wines . scopola
i^e^ -Testing the strength of a drug by animal experiment
(Vol. 5 j.-The treatment of iSsanity by malaria (228) -The fo lowing
oaraeraphs are interesting among many others : 106, 115, Abb.
P ITdoubt the great difference between the ancient and modern
is one of outlook, which accounts for the ^^^^^^
which appeared interesting and even important in those days is
passed over by modern physiology and pat hology Eadi cenW
Ls its own interest. T%£^^^^*^ tW
^Tu^TdL.™^, fSS all kint come to be out of date,
but the epithets "right," "wrong" do not apply. The more
carefully we observe modern science the more evident does it become
that iustTts terminology and subject of conversation is different.
Things are seen from new angles, and things only surmised at then are

amenable to tangible description now. qi restive

Tn fact there occur moments, even at this day, when suggestive

thoughts migh be drawn from the Canon, to help in studying the

Sdual, tf dious, or baffling case especially whe« the p^£»

far distant from the laboratories and appliances of modern medicine.

V
Of Interest to the Scholar.

8 38. The present translation is based on the Latin versions
published at Venice in 1608 and i 59 5, support ed ^ a s tucly °f the
Arabic edition printed at Rome in 1 593 and the Bulaq edition

It is true that as E. G. Browne^ p. 34) pointed out, the Latin
Oanun swarms with barbarous words which are not merely tran-

S^Sn many cases ^^.^^^^^£"^3
of Arabic originals," and that Hirschberg and Lippert regard
the Latin as almost unintelligible though they admit he slav sh
adherence" of the Latin to the Arabic Campbell (p. ■ £39)
states that there was a " society of translators at To edo about
ino AD, "whose method of translating from Arabic to Latin
was to put the Latin equivalent over the Arabic words, dis-
r e tard°ng P Se sense of the original." It is true that m many passages
thf obscurity is similar to the effect which would result if one were at
this day to render idiomatic French word ^ word ^nto a^hsh.

It is important to point out that the Latin of Volume I is very
different from that of Vols. III-V ; so different that th< ;tra^on
must have been the work of different persons. While the criticisms
Se justified with regard to these three volumes, they do not apply to

THE CANON OF MEDICINE I9

the first whose Latin is very close to the Arabic, and hardly to be
improved. The difficulty really is that the Arabic itself is so con-
densed that the meaning can only be clearly represented in English
by the use of many more words, whether to help out the meaning
itselt, or to make a presentable reading.

_ It may well be said, as did E. G. Browne 6 fp. 26, 27) ■ " he who
judges Arabian Medicine only by the Latin translation wili inevitably
under-value it and do it a great injustice. Indeed it is difficult to
resist the conclusion that many passages in the Latin version of the
yanun of Avicenna were misunderstood or not understood at all bv
the translator and consequently can never have conveyed a clear idea
to the reader.

T , §39- The following aids to clearness have been utilized, (a)
The study of Avicenna's other works, and of contemporary philo-
sophical writings, m the existing translations, (b) The study of
various Latin terms as understood by modern scholastic philosophy
m its exposition of the mediaeval nomenclature. (A The use of
modern terms when there is no reasonable doubt of their referring to
the same idea, though the literal term in the Latin is obsolete The
careful study of the original Arabic has here been of special
importance for words in the Latin version, which are evidently
technical there, become merely colloquial when translated into
English, whereas in the Arabic version, such words at once take on
their proper character in the Arabic-English and Persian-English
dictionaries (d) The use of tabulation of the matter. There are
instances where this proves possible without omitting even a single
Arabic word. (,) The use of paraphrase for certain passage
These are marked (p). A certain freedom of rendering has been
inevitable m view of the importance of bringing the full meaning of
the text to the reader s notice without subjecting him to the need of

ori|Sal A b ? *° n PaSSagC after paSSage ~ as is re quisite with the

§ 40. The main purpose of this treatise will now be seen to
centre m the idea that in the ancient philosophy there is material
capable of useful application to-day. The selection of the work of
Avicenna is not intended to provide an apologium for that one
author, but is specially appropriate for these reasons : (i) his
acknowledged excellence ; (ii) his greater accessibility among
mediaeval medical writings ; (iii) a certain indefinable charm of
expression peculiar to himself. But above all, (iv) the fact thaThis
central theme is a conception of the nature of the human being really
identical with that of Thomistic philosophy, and in theie days
specially stressed and developed by « modern scholastic philosophy ''
As these are related, so might Avicenna be related to a modern

2Q THE CANON OF MEDICINE

,he ° wa Mercier" " we do not regard the Thomistic philosophy
kWar^tXm wLht^ ^her arid" (footnote,

P ' 3 With Maher ■««"... resuscitate and " (apply to Medicine)
« W a p^ycho'logy that has already survived four and twenty
centuries, Ed has Ed more influence ; on human though and human

( S 3) &££J^n*^^c1w# " — "Se
Crudely expressed or perhaps faultily explained, ,t rs our pnvlege

under 4 d1fferlnt°gatbs are not obliged to accord the* .garbs an ^

SnfldentThatX Zt S^Xurtsire^not so intangMe
as at first appeared.

" I deemed life was tranquillity and rest,
I find it but a never-ending quest ;

And I, who sat in q^d e a nd P ea ^ „ (Shamshad.-)
Toil on a journey that shall never cease. (

•• Why should the Cosmos turn its wheel of worlds
If not to search for Thee eternally ?
Why should the tireless Sun arise each morn

If not to look for Thee ? " *■

At last I found Thee hidden in my arms (Za uq.»)

Within my breast ! v.

THE CANON OF MEDICINE

§ 43. That which is spread before us, beneath the unceasing
surge and change of the crowded life of the thoroughfares of great
cities, as well as beneath the panorama of Nature herself, was surely
understood by those who insisted " there is no second Cause," and by
Chu Hsi 11 in saying " the innumerable laws (of Nature) all proceed
from one source" (p. 137). In this the thought is not pietistically of a
Creator, .but of a living Reality met (passively or receptively) or
encountered (actively or contestingly) by us all at all times. That
Reality must be understood before we handle the problem of our
patient with real efficacy.

§ 44. In the intention of this work, then, there comes into
consideration that greater Art of Medicine— not an ethical Hippo-
cratic ideal, but something of the divine— an Art as real to Avicenna,
philosopher, poet, musician, the worker among the great and the
small, aware of the dramatic in Life, as it should be to us. So we
step out of the world of the modern critic, the scholar, and the medical
historian, indeed of modern medicine itself, into one in which we
stand, as it were, hand in hand, with the great Master of the East—
almost with his very eyes gazing upon and scrutinising this ever open
book of Life of ours — divested of the false notions of " progress " and
"time." His language is thus no longer alien— and, incidentally,
he lives again !

Introductory Words

N the first place we render thanks to Allah, for

1 the very excellence of the order of His creation,

and the abundance of His benefits. His

Ih^ and tne aDunuancc ui n« —
#\^> mercies are upon all the prophets. _

fc J 2. In the next place, I may say that _ it

ifiLi is at the request of one of my very special
friends,* one whom I feel most bound _ to
consider, that I prepare this book on Medicine setting
forth its general and particular laws to the full extent
necessary, and yet with apt brevity.

3 My plan is to deal with the general aspects of each of
the two divisions of medicine— the speculative and the practical
Then I shall treat of the general principles applicable to the
diagnosis of the properties of the simples, following this with a
detailed account of them. Then I shalHake upthe disorders
which befall each individual member, beginning with an account
of its anatomy, and that of its auxiliary. The anatomy of the
several members and their auxiliaries is dealt with in the first
book. Having completed the account of the anatomy, I shall
show how the health of the member is to be maintained.

4 This subject being completed, I proceed to ageneral
discourse about general diseases -their causes, the signs by
which they are recognized, and the modes of treatment. After
this, I pass on to the special diseases and will point out in as
many cases as possible-(i) the general diagnosis of their
characters, causes and signs, (ii) the special diagnostic features,

^^SmiSi^^ i ?A in oils han g in g in a, ante-
haU ^J^J^W other headings *£*££■«£ —S e u d

letters are taken from the 1608 edition in Latin, the 1523 edition of Haly Abbas,
and various mediaeval illuminated books.

THE CANON OF MEDICINE 23

(iii) the general rules of treatment, (iv) the special methods of
treatment by {a) simples, (^.compounded medicines.

I include specially designed tables under the subject of
simples to enable you to survey the facts rapidly as to the adju-
vants for treating disease by simples.

Compounded medicines, and their adjuvants, and how to
mix them I have deemed it best to consider separately in a
" Formulary." This it is my intention to compose after the
special subjects are dealt with. Disorders not confined to one
member are described in this book ; the cosmetics are spoken,
of ; and the knowledge set forth in previous books is assumed..
Allah helping me to complete this volume, the formulary will!
be added to it.

5. Every follower of my teachings who wishes to use
them profitably should memorize most of this work, even though
he do not quite understand it all.

It is my intention to prepare further volumes if Allah
should prolong my life still further, and if circumstances prove
propitious.

Scheme of Contents

Book I. General^ matters relative to the science of medicine.

1. The definition and scope of medicine. Health.

2. The classification of diseases ; their general causes and

symptoms.

3. The preservation of health and regiminal treatment.

4. The classification of the modes of treatment in general.
Book II. Materia medica.

Book III. Special "pathology " (Medical and Surgical).
Book IV. Special diseases involving more than one member.

The cosmetic art.
Book V. Formulary.

CONTEXTS OF BOOK I*
Part i comprises six theses : —

The definition of medicine. The topics of medicine.
The imponderable elements.
The temperaments and constitutions.
The fluids of the body, and how they arise.

The members (bones," muscles, nerves, arteries, veins) (= tissues and
organs). ' v

6. The faculties of the body: vegetative, sensitive, vital. The power of
locomotion. The functions and operations of the body
Part 2 comprises three theses :— y '

1. Ill-health :

(a) Causes, symptoms.

(b) States of the body ; types of disease.

* The Latin text is abridged here.

24 THE CANON OF MEDICINE

Id) Loss of continuity.

(e) Diseases of the composition.

if) Disfigurements. ,

'(g) The phases or cyles of disease.

2. The" causes of disease :

(a) Atmospheric, seasonal, winds, localities , the sun.
(&) Vegetative functions.
(c) Food and drink.

'" B gnumittion'of the causes of each of the corporeal conditions.

3. Thi Ivfden^es of Ul-health in (a) the pulse, (6) the urine, (c) the feces.
Part 3 comprises five theses : — ,.,,_, ,-u^ „^i

dietetics, fatigue.
?: llSn^p^rfafe to the various constitutions and habits of body.

5 - ^ Arfepitome giving the regimen in special circumstances of life.

Part 4. The treatment of disease. .

* 4 (There are 263 chapters in all.)

K-

$&$&&

In the nams of Allah, the Merciful, the Clement.

BOOK I

w-n K.Y h ^ eVer ht mastere ? the first book of the Qanun, to him nothing
w 11 be hidden of the general and fundamental principles of medicine "—
Chahar Maqala. 7

Part I

THESIS I

i. The Definition of " Medicine "

EDICINE (6) is the science by which we
learn, (V)the various states of'the human
body, (i) in health, (ii) when not in health,
(b) the means by which, (i) health is likely
to be lost, and (ii) when lost, is likely
tobe restored to health. In other words,
it is the art whereby health [the beauty of
the body — long hair, clear complexion,
fragrance and form (Chahar Maqala)] is conserved and
the art whereby it is restored, after being lost.

7. Although some divide " medicine " into a
speculative (theoretical) and a practical (applied) part, you
have assumed that it is wholly speculative " because "
you say " it is pure science." But truly every science has
both a speculative and a practical aspect. Philosophy
has a speculative and a practical side. So has medicine.
The- difference between the two need be explained only
m the case of medicine. Thus

2 6 THE CANON OF MEDICINE

When in regard to medicine, we say that practice proceeds
from Theory, we do not mean that there is one division of
meScne by which we know, and another, distinct therefrom
"y which we act. We mean that, these two ^aspects be ong
together-one deals with the basic principles of knowledge he
other with the mode of operation of these principles (with n the
body) The former is theory ; the latter is applied knowledge..
8 " Theory " of medicine is that which, when mastered,
gives us a certain kind of knowledge, apart from any question
of treatment. Thus we say that " there are three forms of fever
and nine -nsntutions.^ ^.^ ^ ^ ^ ^ wh;

physician carries out, but is that branch of medical knowledge
^ch, when acquired, enables one to form an omn on upon
which to base the proper plan of treatment. Thus it is sad
"for inflammatory Vi, the first agents to employ are mfegt
dants, inspissants.'and repellants ; then we temper these with
nToUmcants ; and, finally, when the process" sutadmg
resolvent mollificants will accomplish the rest But it the
SeTed focus contains matter which depends for its expulsion
on the integrity of the principal members, such treatment is
not applicable/ Here J theory guides to an opinion, and the
ooinion is the basis of treatment. .

P Once the purpose of each aspect of medicine is understood
you can become skilled in both, even though there should
never c6me a call for you to exercise your knowledge

10. Another thing— there is no need to assert mat
<< there are three states of the human body-sickness heakh
. and a state which is neither health nor disease The first two
cover everything. Careful consideration of the subject will
mike it clelr to the physician either that the threefold grouping
Tunnecessary or th£ "he group which we reject is unnecessary
The first two states really cover everything. ^aremi
consideration will convince the physician that the third state is
dual— on the one hand an infirmity, and on the other a habit or.
body [some ugliness of form, for instance] or a condition
which cannot be called strict health although the actions and
functions of the body are normal. One must -t risk definmg
" health " in an arbitrary fashion, and include in it a condition
which does not belong to it (/>.).

' However we do not propose to argue this matter out,
because a disputation of that kind does not really further

medicine.

THE CANON OF MEDICINE 2 y

, . § & J 0&nniti * s "- "5unayn ibn Ishaqal-'Ibadi (E. G. Browne', p. i 47 )_
defines Medicine as the science which informs us about the states of the human
body m health, or when it debates :from health ; how to retain health ; how to

rtJgctJ-lJ. XL.

It is concerned with the following : —

i. That which is integral in the nature of the human being. The seven
a n^ + t f Wealthy human being-four being material, essential,
and three formal. The four 'accidental" notes
2. -That which is apart from the nature of the human bein<*
3- Ihe preternatural or abnormal, to which belong the d?seases their
causes and signs. '

and Definition of Medicine as a Profession; the

§ 46. The Scope
motives underlying.

1. Medicine as an exterior Life or Career.

(a) The pursuit of a science. Medicine may J^e taken up as a science in itself
for the sake of science-namely, that science which treats^ of the prevention or
cure of disease ' . This work entails the study of cognate sciences. Lovl of know-
ledge may be the chief motive ; that is, it is an intellectual pursuit ; though othlr
motives may be associated. muugu umw

_ Many branches of medical science are separated off as distinct pursuits-exter-
nal, internal state, psychological, pathological, legal, medicine, eta As a Career
it may be orthodox that is obedient to the laws about practice, etc. ; in which case
it is also obedient so ely to the microbic theory of disease-or unorthodox in varioul
degrees through following different " systems," many of which are unauthorised
and lead to some form of illegal practice. y unauthorized,

If Medicine be regarded as concerned with the nature and constitution of man
(as a matter of the first importance in learning how to maintain health aS I al W?JS
the distresses of ill-health) , it is defined virtually in the same "wa" ^as A^cenna and
conforms also to modern scholastic philosophy. In this case the practitioner
would centre his attention on the individual, the patient himself, rather than on some

S^^^tST and above the disease or infection ; the const=

to jx^&g^*^ arL ^ SClentifiC aS P 6Ct iS hSre ™de subadiaty

t -t, P I j itS P5. imar y. motive, this form of pursuit is of course the pursuit of a live-
lihood, and medicine 1S a form of commercial life. Its success would tw, it
measured by the bank balance. Admittedly this is seldom of M^ Tdegree called
wealth. After a long life of hard work, such a one might grieve at his lack of s„™
did he not simultaneously have motive (ii). For thlse ^ords tht appl^ " "The
only compensation which medicine offers to wealth is the spiritual pleasure of
sacrifice that solemn sweetness which floods our being when weTee the frurt 6f our
pain. The dependence of the soul on the Creator, brings our obligation to Him in
dealing with those under our care. This is what makes the weary dispensarv cUrfic
blossom with a fullness of solace surpassing all expectations" frlST^

(11) Pursuit primarily for humanitarian motives— the alleviation of sufferino-
especially of physical pain ; and of various disabilities. (The actual cure S
is often supposed to be within human scope, though an impartial iud™t
motteT 7 m ° dlfy SUCh ^ idea ' ) Preveilt - e ^Icme is teS ^Tame

§ 47- 2. Medicine as an interior Life. Motives in the strict sense
am1v J a) " W ° rldl y moi jves "—pursuit as a means of satisfying a certain egoism or
bSnesT ° n Part ° f the d0Ct ° r himS6lf ° r ° f MS relations = P-rsuit as S or
a- ^-\ b l Asa J orm °i 'devotion to Fellow-man. Philanthropy, (i) The relief of ™ in
disability, suffering, etc. _ (11) Socio-political motives-theWts of leSlatton^nd
research : sanitary medicine ; state medicine. Industrial medicine OrganiTation
of team work both for research and the << panel." The devrtion if more ?S

28 THE CANON OF MEDICINE

Man in the abstract, the individual not receiving personal contact, as he. does

Under (c) 'As a form of devotion to God. .. means of studving God both

in ^^t^S^^t^^I^tt^^ the purpose or God

^li) The pursuit of practice («) as a penance <* ^£$^^ S£
cell of your heart " So, Avicenna the Sufi seemgtox J V, m perfection

is a disciplinary (Massignon » 11. 51 5)- <£ /^ all a nd God leads each according
» Every soul is on the way to ^^f^'^ g 7 6) . This is the practitioner's
to the means He selects as best ^nquery p. 97 J ^^ fee tQ ac ^ e

" unitive way." To achieve one s ^Vf* ^ ew „ ^ ^ rf ^ L ord

tMf desire. ( C ) A means of realizat on of «ie love 01 „ being

is the beginning of wisdom (Medicine as a r g x will> but through

elusion under this title)-culminating, not tbroug p every organ

divine will, in a consciousness of the H es ^ M £ oUection ma y finally become
and tissue, so that the state ( Hal ) ot r c that expia t io n may be accom-
actual. (d) A means of expiation It is P°^w £ ithout his being aware

plished through the instrumentality o the > P^an^ . g released ^

of the fact. He may be the ^^^o™ On the P other hand, he may fulfil
nesses arising from causes indicated m§ 19* on are t _ f n him

a deeper intention, especially whe * °°™ s *£ J^ of eX pression,-he may become
the devotion of God to man may become capable otp ^ ^ ^.^ of d

the vehicle of God's intention. As the .mas iter : j ^ one Qr two

heard from among the sea of musicians and is on y ^ab de ac y^ utterance of t ^ at

individual in one generation. , it of med icine as an art receives a ^dual

§ 48 . This, the highest aim of the pursuit _oi 1 pat ients, benefiting

reward • the subtle intangible but *^^£f^Sby the spirit of divine love

them unknowingly ; the f » c J^ /Xof absolute realities-into that
whereby is imparted the gift of *m*gW intone realms o ^ ft of

which underlies deeply the appearance of this ^^ | hereby t^e for whom
ability to counsel the P^ents along ^eroad^t too^ ; ^ ^ Neither

this counsel is intended shall P roc ^ fj^as ™ ft Yet the former may recognize
physician nor patient may be consc ous o E this ■ &£. related to

tbe sa^S^^S|SiS ^ "fS S-2S& ffif
J^'^^SS^SS^^^^ - k s of the day need evoke

n ° Sig As°Ibn e u r 'l-Farid (..,. xr8.-r.35) «-^^^S^w^b?S da^
power of lifting oneself *f^^^Z^^£tox above."
task becomes transformed all br ™^? ^ u * -n^nds, and in great cities In
§ 49. In these days, mass-production oi an m™ 5 ^ ^^

those days, individual craftsmanship and ^artistr^ ; m seel ^.^^ ■ all its
days, the organization of mod ^ t1 m ^ b . f the highways, with a certain scorn
fofffis^ted^^e^^a^d 8 ^ leisur.efy solitude, in which could be

—^^hl^^^ma, i steppe ^^S^
lanes, and in our wayfaring find ourselves back .^ those^ ti hiir f ga in a glimpse

and forgotten seer, stay quiet* ^ ^^^^"truth is abiding and
of Something which nothing else can reveai,

irresistible.

THE CANON OF MEDICINE 29

2. The Subject-Matter of Medicine

11. To medicine pertains the (study of the) human body
— how its health is maintained; how it loses health. To know
fully about each of these we must ascertain the causes of both
health and sickness.

12. Now as health and sickness and their causes are
sometimes evident to the senses and sometimes only perceived
by means of the evidence afforded by the various symptoms,
we must m medicine gain a knowledge of the symptoms of health
and sickness.

It is a dictum of the exact sciences that knowledge of a thing
is attained only through a knowledge of the causes and the origins
of the causes. — assuming there to be causes and origins. Con-
sequently our knowledge (of health and sickness) cannot be
complete without an understanding both of symptoms and of
the principles of being.

Symptoms : the word includes our modern " signs " and
" symptoms." Principles of being: this is the topic of scholastic
metaphysics. Only through a knowledge of causes /—compare
the following : —

" It is impossible to know a thing perfectly unless we know its
operation ; since from the mode and species of its operation we
gauge the measure and quality of its power, while the power of a
thing shows forth its nature : because a thing has naturally an
aptitude for work according as it actually has such and such a
nature.

" Now the operation of a thing is twofold, as the Philosopher
teaches (9 Metaph., D.8, viii. 9) ; one that abides in the very worker
and is a perfection of the worker himself, such as to sense, to under-
stand, and to will ; and another that passes into an outward thing
and is a perfection of the thing made, that results from it, such as to
heat, to cut and to build." (Contra Gent. 81 , ii. 1).

13. There are four kinds of " cause " (of health and sick-
ness) : —

1. The material cause — namely, the human subject in a
state of health or disease. The immediate subject is : the
members and the breath. The more remote is : the humours.
The most remote is : the (imponderable) " elements." The
humours and the elements are composites, and they are liable

3 o THE CANON OF MEDICINE

to vary. But though they are subject to a variation of com-
position and change they show a certain constant unity to which
they converge— namely, a unity of "constitution or. of form
ThecoSItitution is in relation to the "change" ; whereas the
" form " is related to the " composition. . .

2." The efficient causes are such as change or maintain the
states of the human body. Namely :—

Extrinsic: the air and affiliated agents:

extrinsic iocaHt . eS) countries> ha bitable regions and the like :

comestibles, potables, and the like.
Intrinsic : movement and its opposite— repose of body and mind ;
including sleep and its opposite-the waking state;
evacuation of secretions and excretions ; and its opposite
— retention thereof :

the changes at the different periods of lite •
occupations ; habits and customs :
descent (race, nationality).
Agents affecting the human body by contact, whether contrary to

nature or not.

n The formal causes : the constitutions ; the composi-
tions ; the faculties proceeding from the constitutions.

8 <o Costaeus, the Annotator of the Canon (1608 ed.) passes
on to speak of health as a " harmony of the composite, the formal
cause ofthe human body." Galen also defined temperament as he
formal cause of the human body. It is exactly here that we find the
S between theology and rationalism, for the former defines the
formarcause of the human being to be what is called " the rational

S U The refutation of the statements is adequately made by S.

Thomas 84 (lxiii), thus : — .

" Harmony cannot move a body or govern it, as neither can a
temperament. A harmony and a temperament also admits oi
de?r P ees The notion of harmony rather befits qualities of the body
than the soul ; thus health is a harmony of the humours ; strength is
a harmony of muscles and bones ; beauty is a harmony of limb and
colour . Harmony may mean either the composition itself or

the principle of composition. Now the soul is not a composition,
because then every part of the soul would have to be the composition
nf the parts of the body. . . . " (1, p- 166). _

Just as the mediaeval physicians fell into the rationalistic error
so ably and thoroughly exposed throughout the Contra Gentiles
when they " freed " themselves from stereotyped teaching, so with

m0de The te ph C yskS and chemical facts which were discovered in the
nineteenth century appeared finally to controvert both the statement
of the Canon and those of the scholastic metaphysicians ; but it is

THE CANON OF MEDICINE 3I

gradually becoming clear to more and more thinkers that this is not
the case.

4. The final causes : the actions or functions. A know-
ledge of these presupposes a knowledge of the faculties and
the breaths (which are the subjects of the faculties) as we shall
show.

14. These then, are the subjects which pertain to
medicine. Familiarity with them gives one insight into how the
body is maintained m a state of health, and how it becomes ill.
A full understanding of how health is conserved, or ill-health
removed depends on understanding the underlying causes of
each of these states and of their "instruments." For example—
the regimen m regard to food, drink, choice of climate, regula-
tions regarding labour and repose, the use of medicines, operative
interference. r

Physicians treat of all these points under three headings,
as will be referredto later— health, sickness, and a state inter-
mediate between the two. But we say that the state which they
call intermediate" is not really a mean between the other two

/ c u i , N °7 that WC have enumerat ed these groups of causes
(of health and sickness) we may proceed to discuss whatever
Medicine has to say concerning (a) the elements ; (b) the con-
stitutions ; (,) the fluids of the body ; (d) the tissues and organs
—simple and composite ; (*) the breaths and their natural,
sensitive and vita faculties ; (/) the functions ; (g) the states of
the body— health, sickness, intermediate conditions ; and
[h) their causes— food, drink, air, water, localities of residence
exercise, repose, age, sex, occupation, customs, race, evacuation'
retention The external accidents to which the body is exposed
from without ; (i) the regimen in regard to food, drink
medicines ; exercises directed to preserving health • (f) the
treatment for each disorder. 8 W

16. With regard to some of these things there is nothing a
physician can do, yet he should recognize what they are, and what
is their essential nature— whether they are really existent or not.
tor a knowledge of some things, he depends on the doctor of
physical science ; in the case of other things, knowledge is
derived by inference [reasoning]. One must presuppose a
knowledge of the accepted principles of the respective sciences
of ongins,_in order to know whatever they are worthy of credence
or not [criteriology] ; and one makes inferences from the other
sciences which are logically antecedent to these. In this manner
one passes up step by step until one reaches the very beginnings

32 THE CANON OF MEDICINE

of all knowledge-namely, pure philosophy ; to wit, meta-

PhyS Hence, if a doctor undertakes the proofs of the existence
of the" elements " and the " constitutions and their deriva-
tive^ from medicine itself he errs, for medicine cannot make
tnTse things dear, belonging as they do to the domain of natural
science.

8 a In reeard to this last sentence note: " It is not the

Gent In 1, refe™e l) to the same, note also the following passage by
t t?-Vk? ?T " (v io<V "motions, molar and molecular,

of Latin and Greek, it will be found necessary . ,m the . e»j «
rel? ion to insist upon a ^S^* HteS^ ^

ability."

17. List of what the physician aims at having a clear
notion of ; what each is, and whether the non-manifest actually
exist or not^ ^^ ^ ^ ^ ? there ?

In what modes are they ? What are they ? How do they arise
2. The temperaments and constitutions. What are tney .

^e&ftbbod, Do they exist? How many

ate ^^ The members and the sense-organs. [The science of

anat 7 7 ' ] The faculties. Do they exist ? How many are there ?
• 6. The functions. [The science of physiology.]

7 The breaths. Do they exist ? How many are there .
Where* are they? What changes in state do ^ey undergo
What are the causes of retardation (lagging) of the breath .

THE CANON OF MEDICINE 33

(Or : the changes in the affective faculties ; and the cause of
their persistence.) ,

8. The causes. How many are there ?

18. The physician must also know how to arrive at
conclusions concerning (i) the causes of illnesses and the indi-
vidual signs thereof ; (2) the method (most likely to) remove
the disorder and so restore health. Wherever they are obscure,
he must be able to assign to them their duration, and recognize
their phases.

R^g

^lip

THESIS II. THE ELEMENTS

LEMENTS. 19. The elements are simple
bodies. They are the primary components
of the human being throughout all its parts,
as well as of all other bodies in their varied and
diverse forms. The various orders of beings
depend for their existence on the intermixture
of the elements.

Elements • Equiv. : cosmic elements ; imponderable elements ;
primordialessenc.es; first-principles; elementary principles ; grades

of radiance. I( ^, n+t „„ » u 1lt

It is important to note that these dements are not ^er, but

have only a virtual existence, as explained more fully below (§ 73 -

309) '" Formae elementorum sunt in mixto virtute, non actum motu. 83
(76. 4. 4. m.)

"I am in water, and earth, and fire, and air. _ (

These four around me, yet of these four I am not

(Shamsi Tabriz, 68 1. 235, 5, p. im.)

A difference must therefore be observed between them and the
literal earth, water, air and fire.

Each of the latter, it must be noted, contains all four elements
imponderable elements, the correspondingly named element being

merely preponderant (cf. § 143). 00 „ OA .

Simple bodies.-That is, simple m the scholastic sense
indivisible. " Simplicity is that quality in virtue of which a sub stance
has neither constitutive nor quantitative parts (Mercier, 5 11. 523)-

20 Natural philosophy speaks of four elements and no
more. The physician must accept this. Two are light, and two
are heavy. The lighter elements are Fire and Air ; the heavier
are Earth and Water.

Four elements and no more.-In Chinese, Buddhist and Ayur-
veda philosophy there are five. In theosophy also a fifth, named
"ether'' is given. The alchemists gave three. Aristotle discussed
a fifth saying " the heaven is not of the nature of the four elements,
but is Sf I fifth body, existing over and above these "-quoted by
S. Thomas 84 (68. i. p. 218). These various statements are not
actually mutually contradictory (cf. § 29).

THE CANON OF MEDICINE 35

Light : equivalents : weak, male (because conferring or

inceptive), positive, active. Heaven.

Heavy : equivalents : strong, female (because recipient),
negative, passive. Earth.

Heaven is man, and earth woman in character ;
. .Whatever heaven sends it, earth cherishes.
When earth lacks heat, heaven sends heat ;
When it lacks moisture and dew, heaven sends them."

(Mesnavi, 57 p. 161.)

21. The Earth. The Earth is an " element " normally
situated at the centre of all existence (see scheme in § 54).
In its nature it is at rest, and all others naturally tend towards it
at however great a distance away they might be. This is because
of its intrinsic weight. It is cold and dry in nature, and it appears
so to our senses as long as it is not interfered with by extraneous
agencies, and obeys its own peculiar nature. It is by means of
the earthy element that the parts of our body are fixed and held
together ■ into a compacted form ; by its means the outward
form is maintained.

" The Earth is the warp and weft of thy body." — (Mesnavi, 5 ' p. 41.)

" Earth " is understood in respect of its principal property of
dryness^ 4 (69, i. p. 234).

22. The Water. The Water is a simple substance
whose position in nature is exterior to the (sphere of the) Earth,
and interior to (that of) the Air. This position is owing to its
relative density. In nature it is cold an d moist. It appears so
to our senses as long as there are no influences to counteract it.
Its purpose in (the world of) creation lies in the fact that it
lends itself readily to dispersion, and consequently assumes
any shape without permanency. In the construction of things,
then, it provides the possibility of their being moulded and spread
out and attempered. Being moist, shapes can be readily fashioned
(with it) and as easily lost (and resolved). Dryness, on the other
hand, permits forms to be assumed only with difficulty, and they
are resolved with similar difficulty. When dryness and moisture
alternate, the former is overruled by the latter, and thus the object
is easily susceptible of being moulded into a form ; whereas if
the moisture were overruled by dryness, the form and features of
the body would become firm and constant. Moisture serves to
protect dryness from friability ; dryness prevents moisture from
dispersing.

36 THE CANON OF MEDICINE

" Verily the likeness of this present life is no other than as water
which we send down from lieaven, and wherewith the produce of
the earth is mixed, of which men eat, and cattle also, until the earth
hath received its vesture and is adorned. The inhabitants thereof
imagine that they had power over the same, but our command
cometh unto it by night or by day, and we render it mown (as reaped
seed-produce: Woking trans.), as though yesterday it had not
abounded with fruits." Quran, x. 24. (p. 5h Gulshan .*.)

Again, more specific still, Quran 18. 45- shows that Water
enters into the plants, and only as long as it is there do they hve.
" The parable of the life of this world : like water which We send
down from the cloud so the herbage of the earth becomes luxuriant
on account of it " : (Woking trans.) " min assama fa khatalatabihi
. . " mingled with— or, as one may paraphrase (cf. the sevenfold
interpretation of the Quran) : " water is the channel of life ; and
note that the water came from the cloud, to which it was itself drawn
by the solar heat ! ,

" Water has especially a life-giving power, since many animals
originated in water, and the seed of all animals is liquid. _ Also the
life of the soul is given by the water of baptism' 84 (ib.^74, m, p. 273).
" Augustine holds ' water ' to mean ' formless matter. . t „

Water may be understood here in the sense of radical moisture
f Paracelsus), which is absolutely essential to life, " H 2 " being thus
as it were an instrument or substrate. The plant cannot shoot out
leaves fiowersandfruitwithout.it; so man cannot thrive without this
radical moisture, or innate moisture. Moreover, on this view the
moisture is conserved by a medium which has ( material humidity
—a concept which brings us to the domain of chemistry.

The watery nature may be called " fluid nature ; pliability ;

So, in the Chinese conception, Forke 23 (p. 271) explains, that
the " fluid " of water is yang, and its substance yin; the fluid ot
earth is yang, and its " substance " yin ; whereas the fluid ot
fire is Yin, and its " substance " Yang. Yin is here understood in
a procreative sense, Yang in a destructive sense.

23. The Air. Air is a simple substance, whose position
in nature is above the sphere of Water, and beneath that of Fire.
This is due to its relative lightness. In nature it is hot and
moist, according to the rule which we have given. Its effect,
and value, in (the world of) creation is to rarefy, and render
things finer, lighter, more delicate, softer, and consequently
better able to move to the higher spheres.

See also under " atmospheric air " (264).

The air-" element," entering into the " breath," is that which
enables us to stretch and contract, and also makes possible the
involuntary movements throughout the body. 38

THE CANON OF MEDICINE 3?

24. The (sphere of the) Fire.

" Ignis est causa omnium ignitorum." — (St. T., 81 iii. 46.)

Fire is a simple substance, which occupies a position in
nature higher than that of the other three elements— namely
the hollow of the sublunary world, for it reaches to the (world of
the) heavens. All things return to it. This is because of its
absolute lightness. In nature it is, hot andjLry. The part
which it plays m the construction of things is that it matures,
rarefies, refines, and intermingles with all things. Its penetra-
tive power enables it to traverse the substance of the air • by
this power it also subdues the sheer coldness of the two heavy
cold elements ; by this power it brings the elementary properties
into harmony.

=-h„ T ^ e d } SeTe ^9 e between the " element " fire, and fire as usually understood is
caXrides ^t^ ^ io \™^, ** " material "' fire, and^esfcanl llkl
canthandes urtica as essential' fire. Or, as stated under "air," there is a

"s^LntW'^^aterial 3 "^ 1106 ° f ** JUSt aS "^" iS " radical '* «

25. The two heavy elements enter more into the con-
struction of the members (and fluids of the body, Costaeus), and
contribute to repose. The two light elements enter more into
the formation of the breaths and contribute to their movement
as well as to the movement of the members— always remember-
ing that it is the form that is the motor (and not the breath.
Ihe form initiates the breaths and through them moves the
organs of the body and the limbs.) So much for the elements.

o-^c=-" Elemen j a subtiliora predominantur in mixta, secundum virtute • sed
grossiora secundum quantitatem."— (Sum. Theol.," 71, i, 2m ■ 91 1 cTm )

inteniJence^^iS/. ^ n0urisMn S flame wM <* im P^ts heat, life," sense and

§52. " It is the form that is the motor and not the breath "

In this sentence is contained the crux of the whole subject " Form "
used m the scholastic sense, has a subtly specific meaning when
applied to the human being. This meaning is gone into in the accom-

Pa r,n g -I XpOSition ' Briefl y> the fo rm when associated with the
solid fluid, and gaseous components (earth, water, air) of the "body"
is called a "living human being," and it accounts for the continual
movement of the " breaths " (life-principle) which manifests to the
onlooker that that human being really is living.

§ "S3- Position in nature.— If the names of the elements are taken
as synonymous with the corresponding words describing mundane
nature, it is evident that earth (land) is higher than " water " ; and
that _ air is above both. The fire (solar heat) is above all But
mystically speaking there is such a relation apart from the P-eo-
graphical one. s

3 8 THE CANON OF MEDICINE

S 54. In the following ^*\<***$^ pUaT^tolema? et°c.)
accord^ to the ^^i^^^^SJSy due to the stand-

Lmetfmes sdentinc-by the several schools of thought.

SCHEME OF THE POSITION OF THE™- " WORLDS " AS
CONCEIVED BY THE ANCIENTS.

The Vacuum. Al-Khala ; la Khala wa la Mala. » Neither vacuum nor plenum »

Elev£ih G He B aver 'TheSmpyrean. The seventh heaven of S. Thomas,". » wholly

luminous " (68, p. 228). . ,!.„„,.„ j+ originates the motions of the

Ptolemy's Empvyan ninth heaven ,

'^SrS^SSS'ta « ix4.lar.tie, ol moment
B( tS tt H ! r "S Zodiacal e =£- ^"Tol t^te^veS
to, Mag *tot of the ted rtars ^^ „

above it." Raghib. quoted m Woking transit yuran us „ 84

^ ^k\ Bht' S^^^^el. Formed from the

Flft h' Ma^ofrel ( T^S^ver by Azrael. Formed from the

Fourth ThSn^^rderoleTg'lsrafil. Formed from the light of

Third Ven Q us b SlS. The world of similitudes. Formed from

Second MeSrf 1 Sef^med from F lk r (reflection).
! IT Moon 'Whitejthen silver. Made from Aether.

" The heaven of the moon." Jill 62 (?-."2)
(Here comes " the horizon between matter and spirit. )
Sublunary world :» The " world of growth and decay.
Fourth Interspace (Furja'). The Human Kingdom.

Fourth Elemental Sphere. Igneous sphere, rvre. { the

Divided by Rabanus into an upper region, the fiery heaven, ana
Olympian heaven.
Third Interspace. The Animal Kingdom.

Third Elemental Sphere. Aerial sphere. Air. heaven, and a lower,

Divided by Rabanus into an upper region, the etnereai
the aerial heaven.
Second Interspace. The Vegetable Kingdom.

Second Elemental Sphere. Aqueous sphere Wate ^ d w aided by A. and F.).
First Interspace. The Inorganic World (chiefly E ana w . ,
It ETeme P ntal Sphere. Terrestrial sphere Earth
Jili refers to seven limbos of the earth" (p. 124).

THE CANON OF MEDICINE

Explanatory Extension of Thesis II

i. Preliminary remarks.
sidered <££&2$* °' ^^ ^ f ° m ' <»> C °-idered statically ; (6) Cou-

(6) Co 3 nsid^red d^icallv. imP ° nderable ^^ : < a > C ° nsidered statica % •
4- Application of the doctrine to biochemistry, histology, etiology, etc.

i. Preliminary Remarks

_ §55. Thesis II is the foundation of the whole Canon, but so
entirely has the doctrine and world-conception of Avicenna been
superseded by modern scientific teaching that the whole of his work
may be said to fall with it.

The fact that for millions of intelligent people this world-
conception (scheme of things, theory of life, Weltanschuung) is an
intense reality m their daily lives (Forked p. 239 ) does not usually
signify, and yet even a training in Western universities does not
dispose them to abandon it.

So too, the daily-recited Breviary still contains the Benedicite
opera omnia, m which the four " elements " sing their praise, just
as for S. Francis in his Song of the Sun they were an instruction
for us to do likewise.

Their immediate dependence for existence upon the continuously
exercised will of the Creator is spoken for both by S. Thomas Aquinas,
in the West and by the Persian Sage in the East. " Even air, water
earth, and fire draw their sustenance from Him, both winter and
summer (Mesnavi). As the mighty servants of God (" to us they
seem lifeless, but to God living," Mesnavi," p. z S ) they offer Him
praise (Quran) and service (Mesnavi).

The modern world-conception sets out that the universe is
composed of chemical elements grouped into compounds, aggregated

still Sst S " S Vary "f fr ° m ^ S l ZG ° f VaSt nebula to the'smlllJ but
still vast suns, down to the fragments of dust beneath our feet •
whereas he modern scholastic philosophy sees in our space-time

iTea of°"h y e a ^T ^ tl^ 1 ^' &nd all ° WS that the ^d«t
idea of heaven beyond the blue " evidenced understanding and not

oSficTtion ° rt ' thG d ° Ctrine Under1 ^ Avicenna if capaHe

4 o THE CANON OF MEDICINE

2. The Doctrine of " Matter " and " Form "
A. Considered Statically

8 56. Inanimate matter, in a state of rest, is ; the -outcome of
two principles, neither of which exists apart from the other These
are : the principle of inertia, or passivity ; the principle : of activity.
The former receives the scholastic term primary matter con-
veniently abridged to m. It is the " material cause of a thing.
The second principle is termed "form," "formal cause ; con-
veniently abridged to /. It is non-material.

» Man is the result of the combined operation of heaven and earth, of the
union of two principles " (Li Ki *', vn. 3- I )-

Every object has its /, but every / is not corporeal, for while
some/'s are intrinsically dependent on matter, others can exist apart

romma er ^^.^ indifferent and undetermined; it will take
an infinite number of active principles /. But as soon as a given m
has "akfn a given/, it ceases'to be indifferent, for it has become » f
The union of m and / results in. a concrete object— matter, _ as
oXaSy understood/ In other words it is said that wher, ^receives
f a physical or corporeal substance (object) appears / 1 i said _to
^'in-to/m " m ; whe'n that has happened we have mf" substantia^
form," the physical substance, " in-formed matter So / is called
the™' formal cause " of a thing. / is also called a determining
principle." It " perfects " or completes m. So, we say, when m
fs completed by / a physical substance appears." /is also called
«' essential form" Correspondingly, it is said to give rise to mf

^''/imparts' distinctive nature to m and fixes the character and
properties and activities resulting from the union. / provides the
" deep intrinsic reason " for mf.

mfmf',mf",mf" . . ■ mf would represent as many diiterent

objects,' whether living or non-living. ^w,V a 1

8 k mf, then, stands for the following concepts : (1) physical

substance, corporeal substance. << Corporeal "because evident ^to

our senses. " Substance" because viewed in its state state—

inactive stationary. Every chemical substance is a different mf.

(2) ' ' nature " Here it is viewed in reference to its powers of activity.

(J) " essence " • here we describe what it is, and say what distinguishes

one mf from another, from all other mfs. In other- words it .has

-transcendental properties "-being, essence, unity, _ distinction

from other beings, truth, and good. Every object is a being. Every

object is a « creature." Every object perceptible by our senses is a

material being. (4) " Constitution.'^ Here we study mf from the

point of view of how it came into being. _ _

8 <Q Every object has three causes for its existence : material,
formal and efficient. That which brings about the union of m
(mSeiai cause) and/ (formal cause) is called tne " efficient cause '<
There is another cause called the " final cause "-namely the reason
for its existence, the reason for its creation.

THE CANON OF MEDICINE 4 i

§ 60. As soon as mf exists, certain qualities become manifest
to our senses, by which we are enabled to form a mental image of the
object— over and above the "transcendental properties" just
referred to. These qualities are called " accidents,''. In the formula,
we represent them by the italic a. A concrete object is therefore
represented more accurately by the symbol mf.a, the dot
showing, that mf forms one essence. To be more exact, then, the
different objects around us would be represented by the formula? mf a
mf.'a', mf."a", mf.'"a"' . . . mf.»a\

§61. A further scholastic term is introduced if we say that
" when mf (' potentiality ') becomes ' actuality,' it is mfa."— This is
another way of saying that until a substance actually exists, it has no
" accidents," or " qualities."

§ 62. The same symbol — mf.a — stands equally for a chemical
atom, a chemical compound — inorganic or organic — however
complex ; for a whole mineral ; for a histological " cell " (microbe,
protozoan, cell-colony, simple or complex), for a whole plant or
animal, or for a human being as a whole. Any object in the universe
—water, stone, tree, mountain, herb, sun— can be represented by
this same symbol. Every object is a " creature " in the Thomistic
sense. Every object is " in-formed " matter. The differences
between them all depend on the /.

§ 63. " Human nature " is " informed matter," bearing certain
properties or marks, and endowed with "existence." Each organ
m the body is "informed matter." Every tissue is "in-formed
matter." The blood, the lymph, the urine, etc., are each of them
"m-formed matter." Every microscopic cell of which the tissues
are composed is merely "in-formed matter." So also is every
chemical entity which composes the cells, and the whole person also
is just "informed matter."

§64. In the case of a living human being there is this complica-
tion that each particle of matter of which he is composed is represented
by mf.a, and the body itself, as a whole, is representable by mf.a. To
picture the whole person more satisfactorily we should employ a capital
letter — say M—to stand for the actual matter of the body ; and the
human " form " would be representable by another capital letter F
for the human " form " differs from all other forms. Hence the
human being is symbolized by MF, rather than by mf.f or mf+f—
both of which would be inaccurate. M=n.mf.a. When death occurs,
MF becomes M and F ; M becomes n.mfa again— simply a collec-
tion of chemical inanimate substances. MF stands for "a human
soul." F is not " soul." F does not exist without M in the first
instance, but after death it does exist without M. However, the
great and important fact is that at the time of death Fis no more like
F at birth ; being different, it is correct to symbolize it as F'.

_ The object of life is not to alter one's character, but to control it so that the
passions never come to light. It is not for us to try and " add a cubit to our stature "
(Mt. 6, 27) but to direct our unchangeable " character " into the very highest al-
truistic direction. The object of life is to prevent the character from determining
the form of one s actions. See §164 i v. s

42 THE CANON OF MEDICINE

Many of the laws operating in the non-living substance mf.a
also occur in MF, though every separate MF follows its own laws.
The laws peculiar to the chemical substances of which the body is
composed necessarily apply in MF, as well as those pertaining to
his being a particular MF. The mere fact of MF being altogether
more elaborate than its component n.mf.a's (which together make M)
does not- abrogate the applications belonging to those component

m fs a fact which is often overlooked. Rationalism, for instance,

assumes that because the lower are still present, the higher must
simply be a variety of them.

" In the living conscious being, this qualitative determining factor (the germinal
principle) takes a still higher form, its range of activity is wider, its power of
applying directing, and disposing of the energy stored in the organism is more
varied and more flexible, but it cannot alter the quantity of the capital funded
in the self-moving machine. If, then, it be the quality of the forces distributed m
the nervous system which the directive power of the soul immediately determines,
the liberation and control of a man's physical activity by his thoughts and volitions
need not necessarily conflict with even the most rigid fulfilment of the law of the
constancy of the quantity of energy." (From P. Couailhac La Liberie et la con-
servation de l'Energie, Paris, 1897, Livre iv. ; quoted -by Mfher 5 , p. 523)-

" If an angel or a demon set a barrel rolling down a hill by even a slight push
the action of such a spirit would involve the invasion of the system of the material
universe by a foreign energy. But this is not the way the soul acts, according to
the philosophy of S. Thomas and Aristotle. Here the soul is part of the living
being a component principle capable of liberating and guiding the transformation of
energies (it selects and stores up) in the constitution of the material organism which
along with its compounds goes to form a single complete individual being. (Maher ,

P ' 4 A°uin not in virtue of its rationality is the forma animale but through the
vegetative and sentient faculties. (Aristotle, quoted m » ix. 239)

8 6s There is an important passage on " matter in the Summa TheoL-
(O 8s Art 1 p 185-6) which brings out the distinction between the ponderable
and the imponderable : the interested reader should really study the whole section
of the Summa, on the " Understanding."-" Matter is twofold common and .«gn ate
or individual ; common, such as flesh and bone ; and individual as this flesh and
these bones. The intellect therefore abstracts the species of a natural thing from
the individual sensible matter, but not from the common sensible matter. . .
Mathematical species, however, can be abstracted by the intellect ^om sensible
matter, not only from individual, but also from common matter , not ^com-
mon intelligible matter, but only from individual matter. . For n ^ble ^natLu is
corporeal matter as subject to sensible qualities, such as being cold ox hot hard or
soft and the like ; while intelligible matter is substance as subject to quantity.
Now itTs manifest' that quantity fs in substance before other sensible qualities are.
Hence quantities, such as number, dimension and figures, w "ch are the term ma
tions of quantity, can be considered apart from sensible quahtie ' ^^ ev £
abstract them from sensible matter. . . . But some things can ;be abstracted ev.n
from common intelligible matter, such as being, unity, power act and thebke , all
these can exist without matter, as is plain regarding immaterial things.

B. Considered Dynamically. Change

" The kettle is silent, though it is boiling all the while." (Mesnavi" p. 261.)

8 66 It is natural to consider the objects of the material world
as being in the first place stationary ; that is, in a state of static being.
But actually they all undergo change, from the highest to the lowest
There is movement either in the object itself, or at the instance ot
some other -object. Hence we now consider the dynamic changes
in mf.a., MF.

THE CANON OF MEDICINE 43

§67. Changes- are of two kinds — " substantial change,"
'\M£idmtjd^Qhm,g£-'' The example of the 1ormeTTs~the chemical
change occurring in the course of chemical reactions, mf.a becomes
mf.'a' . The example of J^dejntajLjG&ajj^is, for instance, when
water becomes steam ; when a person or plant grows ; when a person
becomes emaciated, or an object shrinks in size.

§ 68-. The nature of substantial change is most important in
regard to physiology and pathology. The first step is associated
with a disappearance of the old/, the process called "corruption"
by the scholastics ; in modern words, " disintegration." There
is then a new /' — the new " form," whose appearance is called
" generation."*

§ 69. From the point of view of the causes at work, there are
three steps — an external agent or m£terialj:ajise,,axeceptiye function,
whereby the old m receives a newTT^ncfthe efficient ca use which
brings/' into union with m. ~ ~~~

§ 70. In the view of modern science, of course, the properties of " water "
for instance, appear at the moment when the H, and O meet and unite ; the ap-
pearance of NaCl and H 3 0, again, is adequately explained simply from the union
of NaOH and HC1 in appropriate proportions. But Thomistic science perceives
the need of something further. The water-molecule, or complex of molecules is
something more than the two H atoms linked to oxygen, and this something is the
inert principle of matter m, which releases the old / and accepts the new f 1 . As
Rahilly explains, a molecule or a complex of molecules such as an organism, presents
not only " colligative or summational properties, but also indiscerptible specific
qualities of the whole which cannot be distinctively predicated of or portioned out
among the parts." " We must therefore conceive — not imagine ! — a spatially
complex and disparate aggregate as being in some fundamental sense, one " being. "f

§ 71. The causes of substantial change (the efficient causes) in
inanimate " beings " are the well-known familiar extrinsic "forces
of nature " ; but in the case of living beings, the efficient causes are
the intrinsic ' ^faculties " which they possess. Some of the latter
account for changes of substance, while others have to do with a
change of position — locomotion ; and others again excite a move-
ment in the mind.

§ 72. In the human being, the immediate efficient cause of an
outwardly visible act consists of the muscles and nerves ; behind that
is the more remote efficient cause — the sensuous appetition or desire ;
and behind that is the sensuous cognition, which is an integral
property of MF—a passive act, itself a " faculty." Behind that,
peculiar to the human being, is the all-important final cause. This is
philosophically described as " the means by which perfection of life
is reached "—whether that "perfection" be relative or absolute,
whether the interests of the physical body are served, or the intellectual
life, or whether the highest perfection (i.e. of soul) is the goal in view-
where MF uses M as the " innocent creature of God," in order to
attain true perfection.

*" God is an Abaser and an Exalter. Without these two processes nothing

comes into being." Mesnavi 57 , p. 300.

•f Rahilly, appendix to " Modern Scholastic Philosophy""

In animalibus quae movent seipsa est magis quaedam colligatio partium

quam perfecta continuatio (St Thomas, In VIII. Physic. 1. 7).

44 THE CANON OF MEDICINE

3. The Doctrine of Imponderable Elements
A. Considered statically
§73. (1) Relation of the imponderable elements to " matter"
and " form."-— Bo the elements belong to " primary matter " or to

" form " ?

This problem was discussed in so masterly a fashion by St.
Thomas that his words are still applicable and unsurpassable. _ His
perfect understanding of the nature of matter is combined with a
precision of explanation which should satisfy every student ihe
following quotations may be made : " By the words earth and water
(in Gen. i.Wimary matter itself is signified " and not literal water or
earth (Augustine**, p. 194, S. T. 66,- 1). " The ancient materia
philosophers maintained that primary matter was some corporeal
thing in act, as fire, air, water, or some intermediate substance
(ib. p. 192) " Corporeal matter was impressed with the sub-
stantial form of water, and with the substantial form of earth
(p. 231) " The power possessed by water or earth of producing all
animals resides not in the earth and water themselves, but in the
power originally given to the elements of producing them from
elemental matter " (ib. 71, i, p. 251).

In the note to 19 it is seen that the four elements cannot be
assigned to literal matter. But they cannot be assigned to " form "
either, as they have no being until literal matter has itself come into
being. Hence, while the chemical elements are mf, the imponderable
elements are neither m nor /, for they are inseparable from mf, and
the primary qualities of a thing do not appear until it exists — that is,
till m and /have become mf.—" The two exist because of the one,
but hold not even to this one " (Seng-ts'an, in Susuki 91 , p. 184)—
words used in another connection, but equally applicable.

§74. "Humidity" says Paracelsus 83 (ii. 264) is not_ an
element of water, or burning an element of fire. An element is not
to be defined according to body, substance, or quality. What is
visible to the eyes is only the subject or receptacle." . . . Fire
which burns is not the element of fire as we see it . . . the element of
fire can be present in green wood no less than in fire. . . . Whatever
grows is of the element oLfilsj2ULiS_aso^

fixed i"s of the'7elemenLol.,,earth, Whatever jiQurisJbfi&JsJixanjJie
element' of air, 'and whatever "consumes is from the element of water.
GrowthJ^el a ng^Ji3„J:he^iem£rlL.Q£~fir.-e,' , (Cf. "innate heat" § 140)
""Where that element fails, there is no increment. Except the
element of earth supplied it there would be no end to growth. This
fixes it; that is to say, it supplies a terminus for the element of fire.
So, also, unless the element of air were to act, no nutrition could be
brought about " (Cf. oxygen) " By the air alone all things are nour-
ished. Again, nothing can be dissolved or consumed unless the
element of water be the cause. By it all things are mortified, and
reduced to nothing " (ib. 266). " The invisible elements need to be
sustained, nourished and increased by some visible thing, and at
length they perish with them." In other words, the " elements "

THE CANON OF MEDICINE 4S

only exist as long as there is mf. " Both are interdependent and
related, though their activity goes on without waste or loss."

Each invisible attracts to itself its own. Stones come forth from the
strong spirit of the earth " (ib. li. 279).

1lVh+ J u T C ^P as fS es '. 1 oftei i supposed to be meaningless, become intelligible in the
light of Thomistic philosophy, though according to biographers, Paracelsus would not
have wished to appear to subscribe to that.

§ 75- The imponderable elements must not, however, be con-
fused with " accidents " (a). " Primae quatuor qualitates non sunt
habitus e ementorum " (S. T.™, 49, 4, 1). These primary qualities
torm the link between the object and our own consciousness, for our
knowledge of the universe is really simply a knowledge of those
9 u ^ llt . les (^at^coH^moist^dry) with that of secondary qualities
(subtility, thicknessTBghtness, heaviness, rarity, density, translucence
opacity, brilliance, dullness, etc.). " Sensible matter is corporeal
matter as subject to sensible qualities, such as being cold or hot, hard
or soft, and the like " (ib. Si , 85, i, p. 186).

§ 76. So all the concrete objects of this world— from the granite
mountain to the microscopic protozoon-— are related to one another
in virtue of the imponderables. And in virtue of the same, they are
related to extra-mundane objects (sun, moon, stars). " The matter
of the heavenly bodies and of the elements agree in the character of
potentiality " (ib. 84 ,66,2,p. 199). Since matter cannot exist without
them, the human body itself must also manifest them.

§ 7 2: ( 2 ) The analogy between the four elements and vibration-
rate. The._eArth,eIe^^ a sIowl vibration-
rate, the wa^e£^dement„., K ii.l I .,.a„moj:fi.,,r.apid rate, and" the remaining
elements with still quicker vibration rates, "the slower rates are
coarser^" and the more rapid ones are " finer." Hence as
Avicenna says, the earth and water are "heavy" and the others
are light." The meaning of the imponderable elements is made
more intelligible through the idiom of modern science. But in
making such an analogy we must avoid the common error of equating
things capable of being analogized with the same thing. To compare
»c 1 »™ ent ^ " with vibrati °n-rate, is to compare them with light.
• £ v' i_ ^f? lance >" " spirit," " breath " have all been compared
with light ( lux "). But to pass on to indentify them in any sense
with lux perpetua," and then with "Universal Intellect" is
indefensible, yet even modern thought is not immune from the
ffi y, „ Paracelsus?2 explains "element" as "spirit" (meaning
form, no doubt), which ' ' lives and flourishes " in the visible objects
of Nature as the soul in the body" ..." not indeed," he explains,
that it is of precisely the same essence as a soul, but it corresponds
with a certain degree of resemblance. There is a difference between
the elemental and the eternal soul. . . . For^ie^rstjnatter.QLthe
eiement§ JJL i^

J h£ soul of ^elements is iheJife-of alLxreatedihingi " (ii. 264)
Averrhoes said " of all things the soul is most like light."

The perfect reasoning in dealing with these errors, which is given

4 6

THE CANON OF MEDICINE

by S Thomas in « Contra Gentiles » should be studied by all who

are inclined to award the last word to scientific theories _

are ^clmea t f -. fhe doetrine .-Tte application of the

doctrJe to til suCject-matterif Medicine is simple when th, = element
are represented by their corresponding " tendencies. A few ot the
relays are showl in tabular form, by way of -illustration. Thus :-

Corres-

Name

of
Ele-
ment.

Ten-
dency.

Corres-
ponding
system.

Excre-
tion.

Special
Sense.

Operation

body.

Type

of
mind.

ponding

mental

state.

Earth

Spread-

Skeletal

Faeces

Touch

Gives
shape

Mental
torpor

Obstinacy.
Fear.

Water

ing

Droop-
ing

Down-

Muscular

Urine

Taste

Nutrition

Lympha-
tic

Submis-
sive

Affec-
tionate.

Fire

ward
Rising

Liver.
Blood.

Sweat

Smell

Digestion
Physical
move-
ments

Optimistic

Anger ;
irate Vex-
ation (and
weeping)

Air

To and
fro

Vascular
Cutan-

Saliva

Hearing

Respira-
tion

Cheerful

Humour

Aether

Still-
ness

eous
Nervous.
The hair

Semen

Vision

Reason-
ing

Reflective

Sadness

8 7Q The correspondence between body and mind in virtue
8 79- ine "J p F i ole beine by the " elements," is specially
of the pervasion ot trie wnoie Demg uy mv. > r H . u

elaborated in a particularly interesting manner, by Chu Hsi
t 2 12 where the five elements are taken as the < ' physical counter-
(p.2i4),wne^tnen „ (1 righte0 usness, reverence,

$£do£ sincTrity^whS are P present in all beings, JU st as are the

elements.

§80 . The Buddhist exposition of Jhe humar i being as fl co-P-d ^ five
elements-" ^^er,"' sensation ^g^ action, ^ ^ y

£|e S SbUsS ^intn^of rSS between q body and mind is sought after,
in all periods of history.

ment ,^r°e U t he r ' n in SfSXtion of the creature differs in the
degree of ts clearness and translucence. When the ether win which
^individual is endowed is clear and translucent . . .but neither
the indrvidual s ena crea ,urely desire is un-

P 7i hEante overcome and got rid of, and then we have
avoidable , but rtcan be ^™m g indlv idual is endowed

^"and S tt*e beclouding with creaturely des.re

THE CANON OF MEDICINE 47

to such an extent that it cannot be shaken off, and we have the foolish
and degenerate " (Chu Hsi 10 , i. 117).

§ 82. (4) Associated factors. Since the primary qualities
belong to the elements, the laws of action and " passion " apply
Various aspects of this law are described by the terms : strength-
weakness ; jelal-jemal (Persian) ; qada-qadr (Arabic). These
determine the phenomena of human life, and therefore call for con-
sideration under the dynamic aspects of the doctrine. Statically
they are significant to the physician because they reveal themselves in
variations of functional capacity of organs. With the dominance
ot the several elements we may expect corresponding vigour of the
several systems of the body— e.g. the nutritive faculty, and the liver-
function ; renal functions, etc. The emotional make-up, character
and even talents for art, crafts, literature, politics, etc., attitude towards
life m general—all these are " coloured " by the dominant " element "
The study of the patient's features, gestures, voice, posture, hands
acquires an added meaning, as informing about the strength or
weakness of the several systems and faculties— to a degree which is
not so very inferior to the information afforded by the expensive
instruments of modern clinical research.

See also under " destiny." (§§ in- 115)

" Strength is the manifestation of the positive ether, and weakness
of the negative. Each of these again is either positive, and then
good, or negative, and then < evil.' Strength when good is
righteous straightforward, resolute, majestic, firm ; when evil harsh
proud, soft, irresolute, and false. The Mean (the ideal) is the main-
tenance of these principles in equilibrium." Bruce 10 , p. m.

B. Considered Dynamically.

" T ^ 5 Ve f eme !l ts move unceasingly, succeeding one another in predomin-
ance, m turn, though all always exist simultaneously " (Li Ki«, vih\ I {,3).

" The earthy sign (of the Zodiac) succours the terrestrial earth
ihe water sign (Aquarius) sends moisture to it
The wmdy sign sends the clouds to it,
To draw off unwholesome exhalations'
The fiery sign (Leo) sends forth the heat of the sun
Like a dish heated red-hot in front and behind '
The heaven is busily toiling through the ages,
Just as men labour to provide food for women'
And the earth does the woman's work, and toils
In bearing offspring and suckling them."

Mesnavi"

^ § 8 4u T ^ ™ ovement ° f the elements is mutually opposite
(Sum. Theol." 66 ; p. i 97 ). Change is continually talcing place
within the human being. This change is either cyclical or pro-
gressive. The former characterizes the ordinary phenomena of
physiology, and the latter manifest as " growth " The cyclical
changes of physiology (in its biochemical aspect) may be described
in terms both of the chemical elements and of the" imponderable
elements. To do so by the pictorial title of " the dance of the '

4 8 THE CANON OF MEDICINE

elements " is at once to bring up the atmosphere of the East, and the

very scenery of Avicenna's mind.

" All the four elements are seething in this caldron (the world),
None is at rest, neither earth nor fire nor water nor air
Now earth takes the form of grass on account of desxre,
Now water becomes air, for the sake of this affinity.

• ■■ By way of unity, water becomes fire ;

Fire also becomes air in this expanse, by reason of love.
Se elements wander from place to place hke a pawn,
Sr tne sake of the king's love, not, like you for pastime. _

Shamsi Tabriz" (p. 330).

The changes are the important things ;— not the things in
themselves for matter, after all, only exists in virtue of the ceaselessly
acWcreat ve power of God. Did He withhold the power, at tha
fns aft the matter would cease ; it has no reality apart from His
n entiU S would not be a case of the world being « destroyed
St one of " ceding to be." We are apt to be deceived by matter
and devote our thoughts to this instead of to the changes ; and
nerhaos the " moment of nascence " (§ 91) is even more important
San the chang'Themselves. The greatnessof the ancient « Book
of Changes " (Yi King) is due to the recognition of this principle.
° S8? The advantage of this simile is that it brings out not only
movement of a certain orderly kind, but also rhythm and W;
Ze tTouaht being of such primitive native dances m which the
action requires only two dancers (male and female of course) who
a e? n the presence of many spectators. Each dancer performs
entire^ different movements, and the two never come tnto actual
cfntact The movements are harmonized by the music which is
~ iZ 1? as characteristic and essential as either of the performers.

Further tt will be clear that the feelings of the dancers themselves
do not concern the watchers ; behind their emotions there is the real
meamnt of the dance, and whether the dancers discern that or not
tTe observer should strive to discern it. There may _ be special
affinities or attractions between the dancers of the minuet; but
Stfer their pleasure, their displeasure, their steps, nor the music,

^ Moreterthe^kill of the dancers is not always of the same
degree Irtistic genius may produce greater pkasure in the

1. we K,!t there is something greater even than skill.
^Ts? The h phen rna of^hysiology and pathology may be
view d as a serie's of changes of analogous character th e cy de o
changes in chemical elements, tissue-cells, and other rhythmic
phenomena being studied without neglecting the conception of the

imP T8r ab F:otThe nt doctrine of matter and form it is clear that
with the changes from one chemical compound. to another m Mfce
bourse of the cyclical phenomena, there is a dropping of *e form-
Also, the imponderable elements rearr ange an d blend in to new
modes at the same time. As the author of Gulshan-i-Raz (lines
250-255 and footnote) says :

THE CANON OF MEDICINE 49

" The elements', water, air, fire and earth,

Have taken their station below the heavens ;

Each serving diligently in its own appointed place,

Before or behind which it never sets its foot.

Though all four are contrary in their nature and position,

Still one may see them ever united together.

Inimical are they to each other in essence and form,

Yet united into single bodies by fiat of necessity.
• From them is born the three-fold kingdom of Nature."

_ § 8.7. To present a simple example, for illustration — Glucose,
for instance, would be described as WA 2 F±, each letter representing
the corresponding imponderable element. When this substance
is broken up into alcohol and C0 2 , by the dispersal of the " cohesive
force between the three elements (e.g., by the influence of an " op-
posite " : the yeast-ferment), two portions of WF 2 result, the " air "
having escaped, and the " fire-water " of the aborigines being left
behind. This may be represented pictorially thus :

The germination of seeds may be described in similar terms
lnus, it would be said that the„ethereal undulations from the sun
penetrate the loosened earth round the seeds, and'byTheir successive
shocks affect the particles of matter composing the germinal centre of
me seed. The readjustments of atoms and compounds with oxygen
result in the generation of vital energy. The " earth " (mineral
substances, arid remnants of animal and vegetable matter) mingled
with ^ water (moisture) forms the factor of " heavy elements " (20)
I he air (its oxygen content), " fire " (solar heat), and " aether "
(sunlight) make up the factor of " light elements." The two series
together affect the starch in the seed, bring about its change into
glucose whereby the seed swells until the plumule emerges, and the
rootlets begin to penetrate the soil in search of " water " and " earth "
while the leaves expand to take in the " air," and " aether " by the
aid of fire. y

§88. Expressed in another way, there has been a change of
vibration-rate. Or we might regard the imponderable elements as
compulsorily riding upon the chemical elements during their
metabolic interchanges, although the fire, water, earth or air cannot
De thought of as retaining a sort of identity throughout. It would
De better to use another idiom : the noumenal is coterminous with
JM.xMnome.nal. Or, comparing it with wave^ri^olTTtTr^ If '
tnere were two superimposed curves. When the two curves tally
every dip of one meets a dip in the other. The imponderable dips

5 o THE CANON OF MEDICINE

down a* it were into the world of matter, illuminating the' 1 ocean
of pnysicaf matter" according to the mode (in tensity o -bration^
in which it touches the lower curve. A each .rue o the wave the
former returns into the metaphysical ocean, and in doing so,
the nhvsical matter returns to (momentary) inactivity.
^ P Th Sealing down and building up of substance, in the coupe
of metabolism, is the same as the scholastic corrup *°^Km-
tegration), and "generation" (reconstruction) a ^ ^concurrent
with the changes in the imponderable elements l *J™^*™
nrocess is thought of in their terms, whereas to the physiologist
Se process is worked out in terms of the ^f^2l£rT^ g
So in Chinese philosophy, we are introduced to the alternating
openfng and closng P operations of Nature, which are controlled by
the "Law," as thl pivot controls the opening and closing of a
door "(p U4). (Cf with urooj-nasool in Sufic philosophy.)
d °° § 4 P " Hence le find that Thesis III is ™*% *^g™™
consideration of the imponderables, under the title of tempera-
men "It I the action and "passion" between the opposes
whkh results in " temperament." This conception carried through
Hi aspects of man provides the explanation of the diversity which

^^S-JaW^s^^I^r&re is one and the same
princtpt whiJhllf prevailing in the attempered ^ementary par-
ticles is equipoise of temperament, if produced in ^aUones
excellent and delightful intervals, if apparent m the gestures is
Sace if found in fanguage is eloquence, if produced m*e human
limbs' is beauty (< Though their beauty charm thee Quran Sura
•>* v s2Y if in the qualities of the soul equity. Of this pnncipie me
Soul is enamoured and in search, whatever form it may take, whatever
dress a"ume " (Verses 625-630 of Gulshan-i-Raz ; many other pas-
saees in this poem are equally applicable). _

This therefore forms the introduction to Thesis III.

Applications of the Doctrine

(a) To biochemistry.

8 00 Starting with the conception of matter so far detailed,
bothlSciy "^dynamically, and applying the .dynamic ^aspec *
of the imponderable elements designated as a dance * e may pro
ceed to trace the chemical elements and compoun d th ^f the
VwSv entering as they do in the form of solid and fluid articles 01

tically the whole of this time they are combined but : at the actual
moments of chemical interchange they become free or nascent
tVip moments when f becomes / .

8 7 may be {aid that that moment of nascence is the focus
or the whole purpose, of the cycle of changes which occur in the

THE CANON OF MEDICINE 51

body — anabolic and katabolic. That one moment is the opportunity
for vital actions to actualize. That moment finds its location in
this or that histological unit or tissue-element, which itself is, in a
certain real sense, itself the actualization of that moment ! . This
moment achieved, they become bound once more and steadily
descend the ladder of metabolism until they are found once more
outside the body. To quote from a deep thinker of the early
Victorian age : "Nitrogen, like a half-reclaimed gipsy from the
wilds, is ever seeking to be free again, and, not content with its
own freedom, is ever tempting others not of gipsy blood to escape
from their thraldom" (Religio Chemici, 78 p. 149).

§ 92. At this same vital moment of the cycle, there is a change
of the pivot of function in the substances concerned. All the sub-
stances with which the subject of metabolism deals belong to the
£aib2a^2mEoujids_, whose structure is well known to be described
with the terms straight chain, double-chain, ring-compounds, etc.
With these forms of " skeleton " are associated the various "'side-
chains " which are to the others as the limbs to the body. All the
familiar groups of biochemistry (paraffins, primary and secondary
alcohols, aldehydes, acids, amides, ketones, ethers,' sulphonic acids,
albumoses, leucins, purins, diaminoacids, sugars, etc.) may be
thought of as presenting a sort of individuality which depends more
on the side-chains than on the skeletons, and yet the radicles of which
these side-chains are composed owe their character more to stereo-
chemical position or other relations than to the elements which
belong to them. With change of formula there is no doubt a change
of physical state (colloid, crystalloid), of electrical reaction and so
forth. But the fact of change (Cf. § 83) is still more important,
even than the change of personality or individuality (so to speak).
The pivot of function changes from one element — carbon, e.g. —
to _ another (nitrogen, sulphur, phosphorus, e.g.). The important
thing is that •fro i m..hemg,,£aEhQn-centric,_ the physlolo.gical...pjacesses
,.are„ ,.. nitrogen-xentric, sulpho-centric, ...phpspho-centric. Or, uni-
centricity gives place to duo-centricity (e.g.' sulpho-ferro-centric), or
perhaps multi-centricity (e.g. in albumen), because the function
cannot pass on to a new pivot unless two or more other elements have
come into special association.

For instance, in oxy-centricity, a compound constructed on the
straight-chain skeleton (-C-C-C-C-) may become oxycentric, because
the new basis is -C-C-C- (formation of anhydrides, esters, etc.).
Here the important thing is that the centre of function is -O- and
no longer -C-. In nitro-centricity, the change is associated with the
appearance of -C-N-C-, the centre of function being now -N-, which
is important. In sulpho-centricity, a compound with a group
-C-^-OsH (thio-ethers, allyls, etc.) may arise ; this is quasi-patho-
logical for the human body, and however insignificant the -5- mav
be to' the chemist maybe it is evident to the senses in virtue of a
distinctive odour. Such compounds as sulphocyanides, taurocho-
lates, indoxylsulphates, melanin, various mucins, lardaceous sub-
stances, hair, and the horny skin have an importance of their own,

5 2 THE CANON OF MEDICINE

and some of them form the links between nitro-centric and sulpho-
centric compounds. In phospho-centricity, the dominance of the
phosphorus atom is the culmination of the purpose of the metabolic
change. So the author of Religio Chemici (p. 1 49) said ' ' phosphorus
is in the active condition at the centres of vital action and in the
passive (allotropic) state at the outlying points." In the case 01
lecithin, there are variations of centricity. Its nitrogen, phosphorus,
or hydroxyl may be dominant according to the metabolic circum-
stances, and the subsequent linkages and fate of each successive
derivative is according to those circumstances.

Other elements may come to form important pivots of function,
under-jnore or less exceptional conditions (e.g., arsenic, silicon, etc.).
(§93 ) It is clear then, that we can watch the metabolic processes
fromTfiechemical side as a sort of pageant or procession. But if we
view it as the chemist does, according to syntheses and analyses,
oxidations and reductions, and according to the intermediateproducts
which he discovers when he arrests that pageant, as one might stop
a dance in order to be sure that a certain individual was present or
not, we mav easily come to conclusions quite at variance with the
living truth." Stop the dance, and the illusion is destroyed, i he lite

Vi3.s crone !

'"■""" Theliving cell does not necessarily follow the programme of the
laboratory. Indeed it might be doubted whether any substances as
such ever appear except at the end. The actual process might well be
like a shuffling of cards, whereby the order of the cards is altered
and the order or relative position is the important thing. On the
anabolic side there is always the face ; on the katabohc side there is
always the back. Between the two there are always the same atomic
personalities which remain as it were in the same room but change
about to receive different ranks with respect to one another

Each element may be traced through its various phases, through
compound after compound, its behaviour being modified by the side-
chains, and its importance alter e^ - sojhjtns^rthas <i ^^alpiJ^lsax„.
with the otheli~aritrWie^

servienFlo "another 'element whi^Ja^.^j^M^ssumedj^^V^SM
posffibnT""Eacrirtufir receives homage from its fellows ; each enjoys
a brief reign upon the throne.

§ 94 Such is the chemistry of life, viewed mystically, it is an
incessant movement. Interchanges proceed continually, and not
only in one substance at a time, but in a thousand at a time ; not one
element only (C, H, N, O, S, P) but all of them simultaneously—
not necessarily one ruler, but sometimes co-rulers, in the various
substrates of action ; not all at the same rate, but at different rates
and with different rhythms. .

8 95 (b) In histology.— These pictures of biochemical pro-
cesses must be linked up with what we actually see with the naked eye
and with the microscope. Morphological changes are all mani-
festations of the unseen or invisible biochemical cycles. JNot
"structure first, then function." Not "function first, then struc-
ture " The two are inseparable both in time and place. Hence,

THE CANON OF MEDICINE

however exact his histological knowledge, the physician must hold
clearly before him the activities which only the mind can hold and
piece together and watch. The histological appearance shows us the
processes arrested at a particular moment when some group is
dominant and another " recessive." Its very appearance is artificial,
the produce of reagents acting upon a dead " fixed " protoplasm ;
a reaction between complex dyes and the chemical substances
produced by the fixatives. That which appears to be the permanent
substrate for functions, a definite scaffolding, is quite otherwise.
In the picture given of the dance of the elements in the body, the
" skeleton " seems a base from which side-chains arise and give
purchase for the " dancing " element ; but as a matter of fact the
skeleton, the side-chain, and the element are mutually necessary.
The whole structure is altering the whole time. So with the tissue.
The change of chemical substances entails a change from solid to
colloid, colloid to fluid, fluid to gas or back to colloid ; and while so
doing they becomeperceptible under the microscope as cell-substance,
cell-fluid, cell-juice, tissue-juice ; fluids aggregate and condense into
" cells " (colloid phase) ; cells constantly dissolve or " splay out "
into fluid, or undergo partition from larger and larger particles into
submicroscopic and finally into visible microscopic particles, or else
undergo partition into " supernatant fluids " of simpler chemical
composition. In the course of these changes solids and the like
separate out ; and these last are usually but faultily regarded as
products of metabolism comparable to the goods manufactured in a
factory. The appearance of granules rather than fluid, or precipitate
rather than solution in the tissue, depends on the kind of elements
concerned (mineral atoms, ordinary atom-groups), and the direction
of interchange. See § 125.

Some examples of the steps of the cycle towards visibility :

Fluid phase.

Colloid phase.
Cell-substance

Submicroscopic
character.

Microscopic-
appearance.

Fate.

Homogeneous
" humour "

Spongioplasm

Tissue cell
as a whole

Excretable
substance and
protein deriv-
atives.

Abnormal
humour."

Atrabilious
humour

Less colloidal

Coarse part-
icles (insol-
uble)

Inexcretable
without
medicam entous
aid.

Tissue-fluid

Serum-protein

Aminoacids

Bioplasm ;
occasional
crystalline
deposit

Urea, etc.

Sulphur

Colloid Sulphur
potentially
excretable
phase.

Larger parti-
cles of Sulphur

Cell-granules,
cell-wall

Sulphur
derivatives ;
sulphonic
acids, etc.

54 THE CANON OF MEDICINE

8 06 It is not possible to prepare a fully exact correlation be-
tween the carbon, nitrogen, . phosphorus, and sulphur series and
structure seen under the microscope. Bro^as^x^^c^SS^
series is related to the„ceU-subslanc.e.; the nitrogen an3 jjtospjwrus
sSrleT'a7e"ais^iated with the nuclearjtructure. CertanTEnds o.
cells are associated more with some elements than with others
Moreover one must always bear in mind that the movement is all
through the cell, all through the whole histologic^ unit, Ine
fulfilment of the functions of such a unit implies the simultaneous
movement of all the elements concerned, and each cycle proceeds at a

8 Q7 It is less easy still to present a picture of the movement in
a whole tissue in these terms. Only here and there does some product
emeree which is identifiable by the physiologist and biochemist.
Endless intermediate steps and changes find their concrete expression
in the one product which we perceive as some, detail of cell-structure
under the microscope. We may trace various isolated substances in
certain parts of certain cells of the body, and yet are not able to
dogmatize about them, because in the process of hfe.m the tissue
there is a constant flow of matter, the visible becoming invisible,
and then again visible. That is, the visible food material taken in,
the invisible changes and interchanges of elements and atom groups
(the " metabolism ") and their changing pivots of function ; and the
finally visible product of excretion. If there be a range of variation
froi/a " normal " in the steps of this " dance » there is at least no
doubt that ill-health comes of a change of rhythm when the toot-
falls " are out of time, or some of the " steps " omitted

8 q8 It is clear that if the changes in the imponderable elements
should chance to fail to run concurrently with the breaking down and
building-up of substance (the scholastic corruption or disintegration
and generation or reconstruction), this would also mean a break in the
rhvthm : the wave-motion would not be symmetrical, to use the
S simile; and the body would be" ill ." But il : may -be
added, in passing, that the varying dispositions exhibited by people
are the manifestations of lack of perfect symmetry and synchronism
perfect symmetry would show among other things as a cheertul

1Sp0 8 S oo° n The histology of an organ is the visible sum total of
chemical units, with the atom" groups of ponderable tots
successively formed in the cells and tissues. These constitute the
stage and scenery of the metaphysical " dance "-that of the im-
ponderable elements which interweave and complete the picture of the
living processes. But to understand the picture itself, and seeits
meaning, brings us to questions which must be deferred at this point.

§ ioo. The wonderful insight into the processes taking place in Jae human
body which is afforded by the conception of macrocosm ^ ™" t
used by the alchemists of old, and still rightly used by many thinkers, is sufficient
justification^ ^ .^ & ^^ of ^ beingS; composed of hundreds

of units which have aggregated for a relatively few moments^ We , may ^cal it
simply " a crowd," or we may specify and say what kind of a crowd. As one watches

THE CANON OF MEDICINE 55

it, people come up to it ; . others leave ; others walk by without deviating their
steps. Perhaps in five minutes.it has all dispersed.

What of it ? What was its purpose ? What was its effect ?— here or perhaps
elsewhere ? Perhaps it is subversive of order, anarchical, pathological ■ perhaps
it is simply mechanical, obstructive, congestive.

Such may be observed under the microscope, but we call the components
cells or perhaps excretory products or foreign bodies. To some, such analogising
is fanciful and useless. But that Avicenna found this method of enquiry vastlv
productive and helpful there is no doubt. As a faithful Moslem, too, he would
realize the voice of the Quran, saying, " these things are to you for a sign." Words
belonging not only to the moral law, but also to the law of Nature in all its ramifica-
tions — for the Artificer and the Lawgiver are one.

§ i oi. By the time we have grasped these several aspects and
associated them with the chemical aspect of life, we have formed a
nearer approximation to the true picture of life at that moment of
time. But it has already passed on to something different ! How-
ever, there is no way of keeping pace with that except by under-
standing the cycle of changes in each and every case. Cycles of
incipience, of growth, of maturation, of decay. The reason, or
cause of the change, is to be understood before one can keep pace.

§ 1 02. The causes at work in the dance of the imponderable
elements. — The mutual attr action and repulsion which underlies all
change is to be foundTrnheTe^iFTn the imponderable elements, as it
were by definition. The active and passive qualities of the separate
elements come into play when they are compounded, and (because
they necessarily occur in the same "geographical" spot, and are
only separable by mental analysis) they have to do even with physical
state (solid, fluid, colloid, gaseous) and form (granular, amorphous,
crystalline) and physical property (solubility and insolubility ;
positive or negative electrical charge). Hence they may be said to
affect the direction of movement, whether to less colloid state, or
more colloid, to differentiation or de-differentiation, clearness or
sharpness of reaction, or to confused state.

§ 103. This doctrine may be brought beside the Chinese
principle of Yang and Yin.

To the Yang principle belong the ideas : anterior, south, rising, fecundating
expanding, growth, advancing, strength, order, heat, motion, cheerfulness, life.

To the Yin principle belong : posterior, north, falling, breeding, contracting
decay, retarding, weakness, confusion, cold, rest, anger, death.

In relation to the body : Yang belongs to the breath, the head, the speech
the eyesight, exhaling ; the shape of the body. Yin belongs to the blood, the feet'
the vital force, silence, inhaling ; the " body " itself.

Yang is active, flowing, fullness, straigtitness, music. Yin is passive, tending
to inertia, emptiness, crookedness of form, ceremonial.

There are relations between yang and yin, and hardness or softness and the
organs of the body. (Forke 23 , 216).

" When the ether has the proportions of the yin, and the vang correct and &
harmonious, there is perfection of the ether, and it is equally permeable by all "1
five elements, as in the case of man. When the proportions are unequal, there is
imperfection of the ether, the manifestation of the elements is unequal, as in the
case ofjammals." — Bruce, 10 footnote: i. 115.

§ 104. The idea of Yang and Yin swinging as a pendulum
may add to our conception of life. The rocking of the cradle has the
subtle purpose of throwing the yang and yin into rhythm, and the

At-

5 6 THE CANON OF MEDICINE

movement of the infant's breath into rhythm, which, once started,
will continue for at least an hour or two (See 698.)

S 105 Urooj : NasooL™ Rise and Fall. The anabolic
process belongs to the former ; the katabolic (formation of " effete "
substances, their removal from tissues and organs—whether by
deposition in tissues, as atheroma, or by discharge from the body)
belong to the latter. These terms in Persian mysticism emphasize
the fact of changes and movements running in cycles. Each
individual has his own characteristic cycle of changes ; the move-
ment of the '"' breath " goes by cycles. The life as a whole shows its
cycle being sometimes 75 years, sometimes more, more often much
less ' In addition there are the smaller cycles— waxing and waning
of vital force in a certain rhythm peculiar to the person, and carrying
with it susceptibility or resistance to infection, and the like.

S 106 Other principles : these would be expressed as laws,
which can'be classified into various groups— those belonging to nature
in general ; those belonging to human nature ; those belonging to
our conceptions of life, health, and disease. Law of qa# and qadr ;
construction and destruction ; of distribution ; of interdependence ;
of intention ; of compulsory visibility (discontinuous functions, etc) ;
of desires. Note § 82.

S 107 Cause of synchronism : namely between the two
dancers in the simile ; these dancers being the material element and
the imponderables respectively. This lies in the conception of
" breath " or " life-principle," with its cycles.

S 108 (d) Extramundane and extracorporeal influences on the
human body "in virtue of the common content of the " four elements ."
' That there are definite extracorporeal influences on the meta-
bolic workings of the human body should now be intelligible. The
effect of heat, cold, wet climate, dry climate is well enough known but
is widely ignored, as evidenced by elaborate researches into chronic
articular " rheumatism " being apparently made in every direction

but this. . ,

To go further, and agree with the ancients that epidemics and
the like had relation to planetary influences, is not necessary ; nor is
it necessary to dismiss their possibility off-hand. It is not safe to
argue that there is no relation between the planets and stars and lite
on this earth simply because some relation once thought to be true is
now discredited. If the whole universe is one organic whole, there
cannot but be some relation. _ .

The relation between seasonal irregularities and the interactions
of the ' ' elements ' ' is referred to by Forke 23 (p. 298, footnote), m show-
ing how the Chinese associated each season with the dominance of a

given element. . ,

According to the influences prevailing at the time ot birth, so
is the' endowment of the person born " with such an ether." L.
" toward, the disposition is bright and good ... if untoward, not
Chu Hsi 10 , 85. In time, and with constant self-culture, the
inequality of etherial endowment will of itself disappear." ib., 86.

26.

THESIS III

i. The Temperaments

EMPERAMENT is that quality which results
from the mutual interaction and interpassion
of the four contrary primary qualities residing
within the (imponderable) elements.

There is a fight between the qualities ; a
combat (Costaeus' annotation). " The temper-
ament is something set up by contrary qualities
as a kind of mean between them. ' ' (S. Thomas, S2
Ixiii. p. 165, where " complexio " is rendered
temperament ' as it is throughout the present work.)

" How strange that the elements should be so contrary,
And yet be forced to live together."

Gulshan-i-Raz, 25 p. 26.

27. _ These elements are so minutely intermingled as
each to lie in very intimate relationship to one another. Their
opposite powers, alternately conquer and become conquered
until a state of equilibrium is reached which is uniform through-
out the whole. It is this outcome that is called " the tempera-
ment." r

" Elementum aliquod oportet predominari in omni mixto " 83
49, o, 1. m ; 79, 2, 2m.

" This is a drawn battle." (Costaeus 18 .)

shown n s^er™cfJf n T^^ the h6ading ° f this P age ' four transparent discs are
snown superposed. The discs represent the primary qualities The tinted se?-

SSi KSirt^ eleme ^ S - *"> C6n ^ rin S — ks off^helupef-
different tintf c^T + gether •?• ° nS tem P«ament." As each disc revolves,
,' ^2 -+l ST® mt ° new P 0S1 tions, and thus represent different temperaments

oi^^^ofc^efi 1VidUA)S --- The lateral ^ S6rVe to reca11 principles

The initial letter is taken from a French manuscript of the twelfth century.

5 8 THE CANON OF MEDICINE

28 Inasmuch as the primary powers in the aforesaid
elements are four in number (namely, heat, cold, _ moisture,
dryness), it is evident that the temperaments in bodies under-
going generation and destruction (ana-, kata-bolism) accord

with these powers. . .

30 A simple rational classification is into two modes :
(a) Equable or balanced. Here the contrary qualities are present
to exactly equal degrees of potency— neither of them being in
excess or deficiency. This temperament has a quality which is
exactly the mean between two extremes, (b) Inequable or un-
balanced. Here the quality of the temperament is not an
exquisitely exact mean between the contraries, but tends a little
more to one than to the other. For example, to hot more than to
cold ; to moist more than. to dry ; or contrariwise.

" One or other proves victorious." (Costaeus.) ...,,.

" Fire, water, earth, and air, the four elements of which bodies
are compounded, lose their individual qualities m the compound
bodies, and equipose (equity) is what unites them into homogeneous
compounds." (Lahiji, 25 p. 61). -,

'' When ... the elements attain equilibrium, the beams ot the
spirit world fall upon them." {lb., couplet 615.)

"When it is said that the nature of a man or thing is hot and ot
another is cold, such statements include both the physical element
and the immaterial principle with which they are endowed. Cnu

' The idea of " balance " may be applied to a variety of phenomena
in health and disease-both of body and mind. Lack of balance
brings sickness, and explains death. Examples :— atony ; hyper-
tonicity ; hyperacidity ; excessive trichosis ; the various phenomena
nowadays ascribed to loss of balance in the domain of endocrine
secretions, and hormones. The body may be too cold (subnormal
temperature) ; the mind may be " cool ; the heart may be too
" warm." There may be inadequate repose after mental activity,
leading to loss of mental balance. There is dynamic balance as well
as static balance.

31 (It is to be noted that) a temperament, as understood
by Medicine, is never strictly equable or strictly inequable.
The physician should abide by the philosopher who is aware
that the really " equable" temperament does not actually exist
in the human being any more than it exists in any member.
Moreover the term " equable," used by doctors in their treatises,
does not refer to weight but to an equity of distribution, it is
this distribution which is the primary consideration— whether
one is referring to the body as a whole, or only to some individual

THE CANON OF MEDICINE 59

member ; and the average measure of the elements in it, as to
quantity and quality, is that which (standard) human nature
ought to have — both in best proportion and in equity of distribu-
tion.

As a matter of fact, the mean between excess and deficiency
of qualities, such as is characteristic of man, actually is very
close to the theoretical ideal.

The fact that temperament is concerned with the primary qualities and not
with secondary ones should enable one to avoid the idea of weight (pondus) in regard
to the subject. In the annotation of the 1608 edition there is a reference to Aver-
rhoes, as agreeing with this point. However, if one realises that the " elements " are
" imponderables," it becomes self-evident that Avicenna's dissertation is correct, and
that he himself quite realised the attitude claimed for him in this treatise.

32. Eight varieties of equipoise :• — Human beings show
eight varieties of equable temperament. Equipoise of this kind
does not occur in animals, nor do these even approach to the
equable state we describe for man.

See also § 109 and the quotations there given, which insist on the fundamental
difference between man and animals.

The eight varieties are as follows : —

A. In relation to beings other than man. (i) the equability
of temperament seen in man as compared with other creatures ;
(ii) that which is found in different human beings ; (iii) that which
is taken in relation to external factors, such as race, climate,
atmosphere ; (iv) one taken in comparison with the tempera-
ment of extremes of climate.

B. In relation to the individual himself.

(v) as compared to another person ; (vi) as compared with
the states of one and the same person ; (vii) as compared, one
member with another ; (viii) as compared with the states of
one and the same member at different times.

33. We now discuss each of these modes in turn.

i. Equability of temperament as found in man taken in
comparison with that of other animals. The range is too wide
to be comprehended in one definition, although there are certain
definite limits, upper and lower, beyond which one cannot pass
without the temperament ceasing to be a human one.

ii. This is one which is between the two extreme limits of
the range of temperament shown by a person throughout his
life {p) — namely that shown at the period of his life at which
growth has reached its limit. This, of course, is not the equilib-
rium referred to at the outset of this chapter as only theoretical,
and practically never found in practice — though approximating

60 THE CANON OF MEDICINE

closely to that. Such a person is so near to approximate equa-
bility only as far as corresponds to the co-equation of his members,
or the interchanging contra-action of his hot members (e.g. heart),
with his cold ones (e.g. brain) ; moist ones (e.g. liver) with
dry (e.g. bones). Were all these of equal influence, the resulting
condition would be very near to one of ideal equability, though
not so as regards each individual member, except in the case
of the skin itself, as will be explained later. In regard to the
breaths and principal organs, the temperament cannot possibly
approximate to this exquisite equability ; it oversteps this m
the direction of heat and moisture. The heart and the breath
are the root of life, and they are both very " hot "—indeed to
excess. For life itself depends on the innate heat, and growth
depends on the innate moisture. Indeed the heat is present in
and maintained or " nourished " by moisture*

In the case of the principal organs, of which there are three,
as we shall show in the appropriate place— the brain is cold, but
its coldness does not modify the heat of the heart and liver.
The heart is dry or nearly so, yet its dryness does not alter the
moisture of the brain and liver. Neither is the brain absolutely
and entirely cold, nor the heart absolutely and entirely dry. The
heart is dry compared with the other two ; and the brain is
" cold " compared with the other two.

iii The limits of the third mode are narrower than those or
the first, although still quite wide. This is a special equability
peculiar to the race, climate, geographical position or atmosphere.
The Hindus, in health, have a different equability to the Slavs,
and so on. Each is equable in regard to their own race, but not
in regard to others. So if a Hindu were to develop the tempera-
ment of a Slav he would probably fall ill, and might even die.
So, too, if the temperament of a Slav should come to be that
of 'the Hindu, for the state of his body is contrary. So it
seems that the various inhabitants of the earth have received
a temperament appropriate for the conditions of their particular
climate, and in each case there is a corresponding range between
two extremes. -

iv. The fourth mode is one which is a mean between the
two limits of the range of the climatic temperament. It is more
attempered than the temperaments of the third mode.

v. The fifth mode presents a much narrower range than the
first or third mode. It is the temperament peculiar to each

* Fire "feeds on" air. So innate heat consumes the innate moisture
(Costeus 18 ).

THE CANON OF MEDICINE 61

separate person, in that he is alive, and also in health. It shows
a range between two extremes. — upper and lower. One must
realize that every individual person has a temperament entirely
peculiar to himself, and it is impossible for any other person to
have an identical temperament, or even to approximate thereto.

vi. -The sixth mode is intermediate between those two
limits. When the person has this mode of equability of tempera-
ment it will be the most suitable for him.

vii. ^ The seventh mode is the equability of temperament
characteristic for each of the several members of the body, for
each is different from the other. In the case of bone,' the
equable temperament has dryness more than other qualities ;
in the case of the brain, moistness is more conspicuous ; in
the case of the heart, warmth ; in the case of the nerves, coldness.
Here also there is a range- — upwards or downwards — consistent
with equability, but less than in the before-named modes.

vin. The eighth mode is that form of equable temperament
which is proper for each given member. When it has this par-
ticular temperament it is in the best state possible to it.

34. When we study the matter we find that of all beings,
man is most near to the ideal equable temperament. Of all
races of men, those who live in countries within the equinoctial
circle, away from mountains and seas, approach the ideal equable
temperament more closely than others, and those living in other
countries. It is asserted that the more nearly overhead the sun
is [i.e. in the torrid zone], the greater does the temperament of
the people deviate from the ideal equability. But this is false, for
when the sun is overhead it is less harmful, and alters the atmos-
phere less there than it does with us, or less for those at greater
latitudes than for us — though of course we do not have it
overhead.

In the case of peoples living in the equinoctial zone, the
states of the body are in all cases more like the ideal ; the
atmosphere in these regions exerts no evident deleterious
effects, but is always in harmony with their temperaments.
We have already (elsewhere) expressed our agreement with
this opinion.

In the case of peoples living in the fourth climate, they are
more attempered. The sun's rays are not overhead long enough
to scorch them, but are not as oblique as in the second and third
zones of the earth. Such people are not exposed to cold from
great obliquity of the sun's rays, as occurs in the case of peoples
living at the extreme edge of the fifth climatic zone.

62 THE CANON OF MEDICINE

35 It has already been stated that the chief organs do not
approach closely to the ideal equability of temperament. Of
all members the flesh comes nearest to the ideal ; the skin
comes next, for it is hardly affected by attempered water
(i e water prepared by mixing equal parts of snow water and
boiling water). It may be that the flesh is so well attempered
because the heat of the breath and blood within it is balanced
by the coldness of the nerves. And there is also the fact that
it is not subject to the influence of the body itself, for the fact
that drier and moister elements are equally present in it accounts
for it being well attempered. We know too that its absence of
sensation is another reason why it is not subject to the influence
(of the body). It is only subject to intrinsic factors, or dissimilar
qualities. For, as we know, when things have a common origin,
but are opposite in nature, mutual interaction results, whereas
a thing is not affected by anything whose quality is similar to

itself (j>). . , r ,

36 The most attempered part of the skm is that of the
hands " The most attempered part of the skin of the hands is
that of the palms and soles. The most attempered part of the
skin of the palms of the hands is that of the finger-pulps. The
most attempered part of the skin of the finger-pulp is that of the
index The pulp of the tip of the index-finger is the most
sensitive, and that of the other finger tips is more sensitive than
other parts, because they judge of the nature of tactile qualities.
There must be a lessening of sensitiveness from the middle
outwards in order that one can perceive a deviation from equa-
bility.

" The more the organ of touch is reduced to an equable com-
plexion, the more sensitive will be the touch." (S.T., 84 76, 5 ; p. 44,
trans.)

37. In saying a medicine is of equable temperament, we
do not use this expression in the absolute sense, because that
would be an impossibility. Nor do we mean that it is attempered
correspondingly to the human temperament, for in order to be
that the medicine would have to be actually composed of human
substance. We mean this— that when the medicine is exposed
to the action of the innate heat within the human body, its quality
will not over-reach either of the limits (of equable temperament)
proper to the human being. Consequently it will not produce
an effect beyond those limits. Therefore, in regard to its actions
within the human body it is attempered, of equable temperament.

THE CANON OF MEDICINE 63

Similarly, when 'we say a drug is hot or cold, we do not
mean an absolute heat or coldness of substance, or that it is
hotter or colder in substance than is the human body. Otherwise
it would imply that the drug has a temperament like that of man —
equable. What we mean by the statement is that through the
drug hotness or coldness comes to the body, in a degree over and
above that degree of heat or cold which is in the body already.
Consequently a medicament may be at the same time cold — ■
that is, compared with the human body< — and hot — that is,
compared with the body of a scorpion ; it may be at the same
time hot — that is, compared with the human body — and cold' —
that is, compared with the body of a serpent. More than that, a
medicament may be hotter towards the body of Peter than it is
to the body of Paul. It is important to know this when choosing
medicines with the object of altering the temperament. One
must take care not to employ a medicament which from its very
nature could not have the effect desired.

38. Now that we have explained the subject of equable
temperament sufficiently we pass on to consider the inequable
temperaments (" intemperaments" dyscrasias).

They are classified according to race, individual, and organs.
There are eight variants, all of which agree in being contrary
to the eight equable temperaments named above.

(A) the simple types show a deviation from the normal
equipoise only in respect of one contrary.

(B) the compound types show a deviation from the normal
equipoise in respect of two contraries at once.

39. A. The simple intemperaments are as follows : —

(a) where it is an active contrary quality which is in excess :
(i) hotter than it should be, not moister or drier.

Hot intemperament.
(ii) colder than it should be, not moister or drier.
Cold intemperament.
(P) where it' is a passive contrary quality which is in excess :
(iii) drier than it should be, but not hotter nor colder.

Dry intemperament.

(iv) moister than it should be, but not hotter nor

colder. Moist intemperament.

These four intemperaments are only temporary, for when

too hot, the body becomes drier than it should be ; when too

cold, the body becomes moister than it should be, by assuming

extraneous moisture ; when much too moist, coldness supervenes

more rapidly than dryness would. If the dryness be not very

6 4 THE CANON OF MEDICINE

great, the body may remain in that temperament for a con-
siderable time, though ultimately it will become colder than
it should be.

It will be clear, then, that equipoise and health depend
more upon heat than upon cold.

So much for the four simple intemperaments.

40. The compound intemperaments. The four compound
intemperaments are those in which there is a departure from
equability in respect of two contraries. Thus, the temperament
may be at the same time hotter and moister than it should,
hotter and drier than it should, colder and moister than it
should, colder and drier than it should. Obviously it cannot
be simultaneously hotter and colder, or drier and moisten

41. Each of these intemperaments is further subdivisible
into two forms (thus making sixteen intemperaments). {a)
Those apart from any material substance — (qualitative ; formal).
Here the temperament is altered only in regard to one quality,
because the fluid pervading it has the same quality as that
towards which the body is being changed as a whole. Yet
it does not do so unless it be in virtue, e.g., of heat (in fever)
or cold (extraneous cold).

(b) Those in which some material substance is concerned
(material). Here the body is only affected by the quality of
the intemperament in virtue of the increased amount of some
particular body-fluid. For instance, the body is cooled by
vitreous serous humour ; heated by leek-green choleric humour.

42. Examples of the sixteen intemperaments are given
in the third and fourth volumes.

43. Intemperaments in which some material substance is
concerned occur in two modes : a member may be pervaded
bv the material substance entering from without, or it may be
pervaded by the material substance which has reached the
tissues of the body and fails to get out through the orifices of
the channels or from the cavities of the body. Such retention of
material may be the beginning of the formation of an inflam-
matory mass.

This completes the chapter on intemperaments.

44. The physician is again reminded that he must seek
an explanation of the deepei intricacies of this subject m
[esoteric] philosophy, for they are not self-evident.

THE CANON OF MEDICINE

The Temperament of the Several Members
45.

LLAH most Beneficent has furnished every
animal and each of its members with a
temperament which is entirely the most ap-
propriate and best adapted for the perform-
ance of its functions and passive states. —
The proof of this belongs to philosophy
and not to medicine.

" An artificer produces divers works of art. (S. Thos, 84
65, p. 186.)

" Every creature exists for its own proper art and per-
fection." {lb., p. 184.)

46. In the case of man, He has bestowed upon him the
most befitting temperament possible of all in this world, as well
as faculties corresponding to all the active and passive states
of man. Each organ and member has also received the proper
temperament requisite for its function. Some he has made
hotter, others colder, others drier, and others moister.

§ 109. " The human body is the most noble of all lower bodies,
and by the equability of its temperament is most like the heaven
which is free from all contrariety." 82 (i. 70, p. 178 trans.)

" He gave each thing its limits and all things their disposition."
(ib., ii. 26, p. 49.)

" God makes man after one type and a horse after another ;
the types of things are manifold in the divine mind." (ib., i. 54,
p. 118).

" Lord, Thou hast ordered all things in number, weight and
measure." (Wisd. xi. 21.)

" There is diversity and inequality in things created — not by
chance, not as a result of diversity of matter, not on account of
certain causes or merits intervening, but from God's own intention ;
in that He willed to give the creature such perfection as it was possible
for it to have." 82 (ii. xlv, p. 108)

We may also quote from the Chinese. — " All beings possess the
five imponderables, but only man has them in perfect balance as the
constitution of his Nature." " That which differentiates man from
the brute is his possession of the Mean or Equilibrium, that perfect
balance of the elements in the constitution of his Nature of which
Tzu-Ssu teaches in his famous classic — the Doctrine of the Mean."
(Chu Hsi, 11 214, 217.)

"In the life of men and other creatures, the Nature with which
they are endowed differs from the very beginning in the degree of

66 THE CANON OF MEDICINE

its perfection. But even within the differing degrees of perfection
there is the further variation in respect of clearness andtranslucence."

(ChuHsi, 10 i., p. 57-) :,.,.. J , • * ■ i ' ■ • i

" When the ether received is limited, the immaterial principle
received is also correspondingly limited. Thus, the physical constitu-
tion of dogs and horses being as it is, their functions are correspond-
ingly limited in their range," (#., p. 6o.) " Man receives the ether
in its perfection, and the ethical principle permeates it completely
and without impediment ; while in the case of other creatures, m
which it is imperfect, the ethical principle is impeded and un-
intelligent. He receives the ether of the universe in its perfection,
and therefore possesses moral and intellectual faculties." (p. 67.)
" In birds and animals, though they possess the Nature, it is
restricted by the corporeal element, which creates an impenetrable
barrier" 10 (p. 61.)

47 o In order of degree of Heat.

1. The Breath is the hottest, and the heart in which it

arises.

2. The Blood. Though this is generated in the liver, it

derives more of its heat from the heart than from
the liver, the two organs being in continuity.

3. The liver, which may be looked upon as concentrated

blood.

4. The " flesh," which would be as hot as the liver were

it not for the nervous tissue (cold temperament !)
which pervades it.

5. The muscles which are cooler than the " flesh "

because of their tendons and ligaments, as well as
the nerves.

6. The spleen. The faex of the blood makes this colder.

7. The kidneys contain relatively less blood.

8. The walls of the arteries. These are warm in spite

of the nerve substance present, because they receive
heat from the blood and the breaths within them.

9. The walls of the veins, which owe their heat to the

blood alone.
10. The skin of the palms and soles.
48, In order of degree of Coldness.

1 . The coldest thing in the body is the serous humour.—
2. Next in degree, the hairs. — 3. The bones. — 4. The Carti-
lage. — 5. The ligaments.— 6. Tendon.— 7. The membranes.
8. The nerves. — 9. The spinal cord. — 10. The brain. — 11.
Fat. — 12. The oil of the body. — 13. The skin.

(In general, organs rich in blood are of hot temperament ;
those poor in blood are of cold temperament. — Aegineta.)

THE CANON OF MEDICINE 67

49. In order of degree of Moisture.

1. The serous humour is the most moist constituent of

the body. — 2. The blood. — 3. The oil. — 4. The fat. —

5. The brain. — 6. The spinal cord. — 7. The breasts and

testicles. — 8. The lung. — 9. The liver. — 10. The spleen. —

11. The kidneys. — 12. The muscles. — 13. The skin.

The order here given is that of Galen, but in the case of

the lung the moisture is not inherent in its nature but is derived

from the nourishment which comes to it. The lung is fed by a

very " hot " blood, because there is much bilious humour in the

blood going to the lung. A great excess of moisture accumulates

in the lung from the gaseous products of the whole body as well

as from the materials which flow down to it from the " head."

In actual fact the liver is intrinsically moister than the lung,
whereas the lung is as it were constantly sprinkled with moisture ;
it is the fact that the moisture lingers in it that makes it so soft
(to the feel).

One should conceive of the states of the serous humour
and blood in a similar way. The serous humour is moist in that
it is as it were sprinkled with moisture. In the case of the blood
the moisture interpenetrates, pervades, and grows through its
very substance. It is true that the serous humour, watery in
nature., generally possesses much more moisture in itself than
the blood does. And if the digestive changes in the blood proceed
inadequately it loses not a little moisture — namely, the moisture
of the naturally watery serous humour, which has become part
of the blood. As we shall see later, the normal serous humour
is nothing more than imperfectly digested blood.
50. In order of Dryness.

1. The driest thing in the body is the hair, for this comes
from the ethereal element carrying up with it the material
dispersed to it from the rest of the body, which is then left
behind in the hair as pure fumosity.

2. The bone. This is the hardest of all the members.
It is however moister than hair, because bone is derived from the
blood, and its fume is dry, so that it dries up the humours
naturally located in the bones. This accounts for the fact that
many animals thrive on bones, whereas no animal thrives on
hair— or at least it would be a very exceptional thing if hair
ever did provide nourishment. Some think that bats can digest
hair and live on it. The proof that bone is moister than hair is
that when equal weights of bones and hair are distilled in a retort,
more water and oil will flow and less " faex " will remain.

5-
6.

7-
...8.

io.

1 1.

12.

7W.E CANON OF MEDICINE

Cartilage.

Ligaments.

Tendon.

Serous membranes.

Arteries.

Veins.

Motor -nerves.

Heart.

Sensory Nerves.

Skin.

The motor nerves are colder and drier at the same time,
and are therefore in equipoise. The sensory nerves are colder
but not drier in proportion, and are probably very nearly in
equipoise, since their coldness is not very far distant from that of
the motor nerves.

§ no. Link between soul, passions, temperament. S.Thomas 84
writes (ii. 63, p. 166) : " The soul rules the body, and curbs the
passions that result from the temperament. For by temperament
some are more prone than others to desire or anger, and yet refrain
more from these things."

3. The Temperaments belonging to Age
Sex, Place of Residence, Occupation
51. There are four periods of life.

Period.

Title.

Name.

Years of age.

II.

III.

IV.

The period of growth.
The prime of life.
Elderly life.

Decrepit age.

Adolescence.
Period of beauty.
Period of decline.
Senescence.
Senility.

Up to 30.
Up to 3 5 or 40.
Up to about 60.

To the end of

life.

In the third period, the best vigour has passed, and the
intellectual power begins to decline.

In the fourth period, vigour and intellectual power both
obviously decline.

52. The First Period of Life.

THE CANON OF MEDICINE

6 9

Sub-
division

Name.

First.
Second.

Third.

Fourth.
Fifth.

Infancy
Babyhood.

Childhood.

Juvenility.
" Puberty."
Youth.

Distinctive Characters.

The period before the limbs are fitted for

walking.
The period of formation of teeth. Walking

has been learnt, but is not steady. The

gums are not full of teeth.
The body shows strength of movement.

The teeth are fully out. Pollutions have

not yet appeared.
The period up to the development of hair

on the face and pubes. Pollutions begin.
The period up to the limit of growth of the

body (to the beginning of adult life).

Period of athletic power.

The temperament during the whole of this period of life
is almost equable as regards " heat," but " moisture " is in
excess. There has been not a little controversy among older
writers about the degree of heat during the period of juvenility
as compared with that of youth. Some argue that the heat is
greater in the former than the latter, and that this accounts for
their growth, and for the fact that their natural functions of
appetite^ and digestion are greater in vigour and persist longer.
This, it is considered, is due to a condensation of the innate heat
derived from the sperm.

53. Others argue that the innate heat of youth is far
greater than that of juvenility, because (a) their blood is much
more plentiful and is thicker. — evidenced by the frequency with
which nose-bleeding occurs ; (F) their temperament approaches
that of bile, whereas that of juvenility approaches that of serous
humour. ^ (The evidence of an undue proportion of bilious
humour in a temperament is (i) that the diseases in such a person
are " hot " — e.g. tertian fever ; (ii) the vomitus is bilious ; (iii)
other facts.) (c) The movements of the body are more energetic
m youth ; and bodily movement requires plentiful innate
heat, (d) Digestion is better and more vigorous ; and this
entails expenditure of heat. The signs of a vigorous digestion
are :_ absence of feeling of nausea ; absence of fermentative
vomiting ; absence of crudity or aversion to food. These occur
in juveniles when their digestive power is disturbed, (e) The
appetite is less in youth than in juvenility. This shows that the
innate heat is greater, for the appetite is better in a cold tempera-
ment. A dog's appetite is often accounted for by cold tempera-

70 THE CANON OF MEDICINE

ment. (f) The process of growth, greater in juveniles, requires
adequate moisture rather than heat, (jf) The diseases to which
juveniles are liable are usually cold and moist ; and when fevers
occur in them, they are pituitous. If vomiting occurs it is usually
serous.

These then are the two theories and the facts on which they
are based.

54. Galen s teaching. — Galen is opposed to both. In
his opinion the heat is actually the same in each. The difference
is that in puberty its quantity is great but its acuity is less. In
youth the heat is less in quantity but greater in acuity. As he
says — let us imagine first a single measure of " heat," or a subtle
body of unit heat, penetrating into an abundance of moist
substance — as it might be, water. Then imagine a unit of
heat penetrating into a small bulk of stone. The heat in the
water would then be large in quantity but soft in quality, whereas
the heat in the stone would be less in amount but of great acuity.
This is analogous to the state of affairs in regard to the heat of
juvenility and of youth.

55. Juveniles derive their (innate) heat from the sperm,
which is very " hot." This initial innate heat is being steadily
used up, but the loss is made up by the progressive growth ;
indeed it is more than made up. — But during the period of youth,
there is nothing to make good such loss of innate heat. On the
contrary, the degree of innate moisture is lessening both in
quantity and quality, — this being the mechanism by which the
innate heat remains at a constant level up to senescence. Ulti-
mately, the moisture is in too small a proportion to enable the
innate heat to be maintained constant. During all this period
there is no corresponding growth. — At the outset of life, the
innate moisture suffices for the two requirements — maintenance
of innate heat ; growth. But there comes a time when one or
other or both must fail. Innate heat must be adequate to enable
growth to take place, yet the basis of growth — innate moisture —
is failing. So how can growth possibly continue ? It is clear
then, that growth must cease, for it cannot be that the innate heat
should be sacrificed. This is " the tongue of the case " m (iii.
347) during the period of youth. (/>.)

56. As regards the second theory — that during juvenility
growth is in virtue of moisture rather than in virtue of heat ■ — This'
cannot be true because moisture (m) is the material cause of
growth and m does not unfold or construct itself ; it is not a self-
created " being " ; it only changes in virtue of a formative power

THE CANON OF MEDICINE 71

(/) acting upon it. As a matter of fact this formative power is F —
the " soul," or " nature " — -that which is in the decree of Allah
('umr-i-Allah). This " nature " requires an instrument where-
with to work, and this instrument is the innate heat.

57. So, when people assert that the voracious appetite of
juveniles proceeds simply from their cold temperament, this
also is wrong. A morbid appetite due to coldness of tempera-
ment cannot result in good digestion and nutrition. As a
matter of fact the digestion during the age of juvenility is usually
of the very best. Growth of the body as a whole implies that
more food is being assimilated than is used up. When digestion
is faulty, the cause is either (a) gluttony, eating food voraciously
or inordinately ; or (b) errors of diet — partaking of a diet badly
designed and including articles of food which are unwholesome,
or moist in temperament, or in excess ; (c) neglect of the move-
ment of the bowels and other emunctories, whereby effete matters
accumulate and become knit together in them (which is an
indication for purging) — (d) other emunctories : the lungs
especially need ' ' purgation ' ' by making the respiration deeper and
quicker ; although its power is never as great as it sometimes is
in the second period of life.

This completes Galen's teaching about the temperaments
of juvenility and youth.

58. One must also bear in mind that the innate heat of
the body begins to fail after the prime of life, because the ambient
air dries up the moisture of the body. — and the moisture is m of
of the body.*

The innate heat also helps to dry up this moisture. So
also does the effort involved in the performance of the corporeal
and emotional activities inevitably associated with life.

59. Drying up of the moisture is also aided by the failure
of the " nature " to withstand the steadily and silently increasing
dissipation of the faculties. All the faculties of the body are
finite in duration, as is well-known to natural science. So also
the innate heat is not being replaced for ever. Even were the
innate heat infinite in duration and always bringing about its
changes in the body, so as to maintain a renewal equal to the
loss, the fact that the loss is increasing steadily day after day
inevitably leads to a limit beyond which the loss could not be
made good. A fixed state of dryness would be bound to come.
How much sooner would not this time arrive did both factors
contribute simultaneously towards it ?

* The body is admittedly 95 per cent, water 1

7 i THE CANON OF MEDICINE

60. We see- then that the m, the moisture of the body,
must inevitably come to an end, and the innate heat become
extinguished — and the sooner if another contributory factor to
its destruction be present ; to wit, the extraneous excess of
humour arising out of imperfect digestion of food. _ This
extinguishes the innate heat (a) by smothering it, enclosing it,
and (b) by providing the contrary quality. This extraneous
humour is called the " cold serous humour."

61. This is the death of "nature " to which every person is
destined, and the duration of life depends on the original tempera-
ment, which retains a certain degree of power to the end by
fostering its intrinsic moisture. This is the person's appointed
end, and the diversity of temperaments accounts for the different
durations of each one's life. These are the natural terms of
life. (There are of course, also, premature deaths, brought
about through other causes, though even these are also in accor-
dance with Divine Decree.)

" All things have We created after a fixed decree." (Q. 54, 49.)

" The four elements are as birds tied together by the feet ;
Death, sickness and disease loose their feet asunder.
The moment their feet are loosed from the others,
The bird of each element flies off by itself.
The repulsion of each of these principles and causes
Inflicts every moment a fresh pang on our bodies.
That it may dissolve these composite bodies of ours,
The bird of each part tries to fly away to its origin ;
But the wisdom of God prevents this speedy end,
And preserves their union till the appointed day."

Mesnavi, " p. 162.

§ ill. The " death of nature " may also be explained on the
basis of urooj and nasool (§§ 105, 137), for when the positive and
negative phases in the cycle of the elements and of the breath clash —
that is, enter the phase of kemal (Persian term) the bodily functions all
cease. The kemal phase may be reached long before the allotted
span.

§ 112. The presence of this phase, and its probable duration
before death actually occurs, may be discerned in practice, if the lav-
be understood. This fact throws a significant light on the state-
ments in the Chinese work on the pulse, 98 where the time of death
is foretold from the study of the pulse and other factors—assigning
not a number of hours, or days, but a particular period in the lunar
cycle. Chu Hsi, 11 in ascribing the varying fortunes of individuals
during their life to differences of endowment of Ether (p. 217)
betrays a knowledge of the cyclical changes pertaining to body and
mind, as well as to the outer world at large.

§ 113. It would be fallacious to argue from this that skil-

THE CANON OF MEDICINE 73

ful prognostication of this kind . would render medical . treatment
superfluous. The value of realizing these phases lies in the under-
standing with which measures are applied in order to tide over the
patient during the dangerous period of inertia of vitality, breath or
other factors. '

This would not dispense with the constant sense of "fiat
voluntas. Tua," both on the part of the lay and of the profession

Quotations from the Chinese, for instance, in whom the con-
ception or belief in Fate is vivid and almost dominant, brings no
conviction to those many who claim to have no belief in Fate whatever
Nevertheless a few proverbs may be quoted, as expressing the
conception usefully : " there is a day to be born, and a time to die " •
"before life has been, death has been appointed." "In the beginning
it was decided whether one should have long or short life • whether
one should have honour or poverty." " The swallow living in the
hall does not know the great building is about to be burned " " t±
physician may cure disease, but he cannot heal Fate." " The lucky
physician sees the patient at the end of the disease ; the unlucky
physician sees the patient at the beginning of the disease."
(Plopper, 76 , chap, xi.)

No doubt where a possibility of " destiny " is to be admitted for
one iorm of circumstance, the application of the same principle to
many details of human life is not so readily conceded; That it i«s
allowable for much more than is customarily accepted will be credible
when the existence of occult and inscrutable chains of causes or
attractions operating together is realized.

Fate is supposed by some to be blind ; by others to be the decree
of a far-off Potentate. It is neither. It is the manifestation of a
series of combinations of conditions which by " natural " courses
of sequences operate in the individual human life. Everyone shares
in the weaving of his own web. The web is a by-product in some
great scheme which we need not question. Fate ceases to signify
for such as rise into the Scheme itself. For, to them, their life is as
the throwing of the stone unerringly into the bull's-eye • the inter-
vening events, the debris, what of them ?

§114. Rather than criticize severely the idea of the length of in-
dividual human lives being preordained, Anwari 25 rightly asks (p. 54)

" If destiny be not the arbiter of mundane affairs,
Wherefore are men's states contrary to their wishes ? "

" Who, then can say, ' I am an individual, independent and free
1 can think what I wish, and I can do what I wish ' ? You are not
doing what you wish . . . thinking what you wish ! There are
various thoughts around you in the form of men and animals, who
influence your mind and feeling and thought ; you cannot escape
them. . . . There is always some person stronger than you and
always someone weaker than yourself. . . . Our lives are tied
together and there is a link in which we can see one current running
through all." Rosegarden, 38 1st ed., p. 52.

§115. No doubt "destiny" is often supposed to negative

74 THE CANON OF MEDICINE

"freewill" which is so much insisted on as man's prerogative.
Destiny belongs to the body, freewill to the soul. Or, to be more
accurate it is our Will which is important and not the body, or its
length of life Or, to be still more accurate, by employing the
algfbraic symbols already fixed on-we are born MF ; from that
moment, with each further reception of (feeding on) sights and sounds
oTSher' sense-impressions, we become MF' But the purpose of
human life has been shown to rise quite beyond this, and our goal is
toTecome MF" before we die. In each case M goes into corruption,
but the position of F' and F" is vastly different

» The voices of Nature are the mother of the soul _ * is the
outcome of a consistent usage of << freewill " by the Will m a certain
direction-namely supernatural, combined also with a feeding
(to use the same term as above) on supernatural impressions.

To quote from theology, in which domain we are brought
"supernatural" does not refer to superstitions evil practices, and
hypothetical experiences ; it is a term used in the sense of super-
natural grace " The ordinary human being is body plus rational
soul in the natural order ; but it has been intended that he shall be
body Plus rational soul in the natural order plus soul in the super-
natural order (Irenaeus). " There should be no clash between the
natural order and the supernatural, for both own God for their
Author and one great function of grace is to supernatural^ the
rTtural'life of man by the love of Christ." (O. R. Vassall-Phillips
r SS R 98 o ^i 12) Wherein lies the importance tor a proper
attitude by the physician towards his patient, in regard to the serious
moments of life (among others), when deceit, equivocation, and
concealment of the gravity of the malady are to be deprecated.

62 To sum up, the equable temperament of the period
of juvenility and youth is " hot," whereas that of the last two
periods of life is " cold." The body in juvenility is additionally
of a moist (equable) temperament, in that growth is proceeding ;
the moistness is shown by the softness of their bones, nerves and
other members, and by the fact that at this age it is not going to
be long before the semen and ether will come to manifestation.
Old persons and those in the " decrepit " age are not only colder
but drier in temperament. This is evidenced by the hardness
of their bones, the roughness of their skin, and the long time which
has elapsed since they produced semen, blood, and the vaporai
(ether) breath. . , ,

Theory 1 ualit 3 is in e q ui P oise durm g J uvenlllt y and 7°^
but the airy and aqueous quality is more abundant m juveniles.
In old persons and in the decrepit, the earthy element is more
predominant than in the other ages. This element is most
marked during the decrepit age.

THE CANON OF MEDICINE J5

p. i62J Earth ^^ t0 ^ 6arth ° f the h0d y [ retum to thy root." (Mesnavi, «

_ The temperament of youth is nearer to equipoise than that
of juveniles^ but compared with them, its temperament is dry •
compared with the third and fourth periods of life, the tempera-
ment of youth is moist. v

The temperament of the decrepit period is drier than in
youth and that of the third period of life in regard to the single
members, but more moist than either in regard to extraneous
moisture. °

63. Temperament in Relation to Sex.

[p^im^^oi^^^^ &mm&Im ,^ t * hat is , h
female is smaller than the male. The female is also mister
The coldness of temperament, as well as the habit of^Iyin^at
home and taking so little exercise, accounts for the accumulation
of excrementitious matters in the female. Their " flesh " is
more fine in ''substance" (texture) than that of the male, though
the flesh of the male is more rarefied in virtue of that which is
admixed with it. The denseness of male flesh renders permeation
through its veins and nerves more difficult.

P^ T 64a T *™ament in Regard to Geographical
««rZ7' , e tem Pf/ ment fiSoister_in the peoples inhabiting
northerly countries, ccJdexin those living in southerly countrief

to* Iemperament in Regard to Occupation —

1 he temperament i^moisterjn those who follow a maritime
occupation ; others are contrary.

66. The Signs of the Temperaments are discussed under
the general and special signs and symptoms.

THESIS IV. THE HUMOURS

UMO URS : Fluids of the body. § 1 16. The word
"humour" does not now bear the sense which
formerly made it an exact equivalent of humor.
In German, " Saft "■would still apply, but "juice"
is unsuitable for the present translation. The term
" fluids of the body" has been selected though
requiring some qualification. Thus, the humour
named " sanguineous " (72), or, simply, " blood " is not to_ be
regarded as identical with the fluid drawn, say by venesection,
and studied before or after clotting. The phlegma is not properly
represented by either " phlegm," " mucus," or " lymph, though
having some resemblances to each. " Serous humour has been
preferred to the older " phlegmatic humour." Similarly, yellow
bile " in the Canon may not be restricted to the fluid in a normal
gall-bladder ; and " black bile " cannot be made synonymous with
(black) pathological gall-bladder contents.

Furthermore, it should be said that the " humours are quasi-
material. In many passages of the Canon it would seem that when
" matter " is spoken of, in connection with disease, humour is
often meant, and particularly a morbid humour. But it is also clear
that behind the humour there is what Paracelsus would call an
" essence," or " radical humour," which itself governs the nature of
the humour and whether or not it is going to become morbid. On
such a view health depends on the maintenance of the essential
humour in a state of purity. ..-,,, r

Again, we may say that the blood is the salt principle ot
the body, the serous humour the " sweet principle," the bilious
humour the " bitter principle," and the atrabilious humour the sour
principle " of the body. According as one or other of these is pre-
dominant in a person, so is his constitution or temperament. In
addition to this, the view of the nature of a humour may be extended
by suggesting, for instance, that fatty acid is an essential of choleric
humour, whereas neutral fat is an essential of sanguineous humour ;
that sulpho-centric substances are an essential of atrabilious humour.
§ 117. The idea belonging to the doctrine of the humours is
not affected by biochemistry or cytology, any more than the theory of
" four elements " is really affected by modern chemistry. To retain
the idea is to claim a practical value in drawing a distinction between
" humours " and the body-fluids. In 101 Avicenna speaks of the'
blood as a product of the liver, the material for its manufacture bemg
derived almost directly from the food itself. As to the blood-cells,

THE CANON OF MEDICINE n

had he known of them he might justly still regard them as incidentals •

as forces accresced_ for a time, and always changing in substance.'

After all they are importations into the blood ; whatever tissue be

their real source, whether their origin is local or widespread, they

are not the real trouble in anemia. Remedies will increase their

numbers, but do not touch the real disorder. From Avicenna's point

of view, it might be said that the glamour of the revelations of the

microscope has only diverted attention from the real " sanguineous

humour and its ultimate sources and similar subtleties, therebv

leading treatment away to " attacks " on the red and white cell

forming organs For the blood is itself living— not a mere chemical

conglomerate. Hence m this field there is a need for reverting to

the old paths The constant endeavour also to reduce everything to

terms of cellular individualities, as opposed to one single complex—

the human being, the one single MF— inevitably carries errors in its

When S. Thomas wrote " Health is a harmonv of the humours "
[banitas est quaedam harmonia humorum) 81 -? 2 (ii 64 p 166) he
was so near the truth as to maintain his place even in these days of
excessively refined details of knowledge.

1.— What a Body-Fluid (Humour : Akhlat) is, and how
many Kinds there are.

67 ;> A body-fluid, or "humour" is that fluid moist
body into which our aliment is transformed.

Healthy, or " good " humour (whether present in the ali-
ment in a pure state or admixed) is such as has the capacity for
becoming transformed into actual body-substance, either by
itself or in combination with something else. In short it is
that which replaces the loss which the body substance' (con-
tinually) undergoes.

wl - +1n Jf 0m tlie , above definition, it is clear that " body-fluid " is not synonymous
with humour. Urine, too, though a fluid, is not a humour.— In a sense b^dv
fluids are the meeting-places between various opposed forces or elements and S
chemical composition is the mode in which such forces or element are expressed
paragrlpr 6 ' *** ^"^ does not <^m to the wording^ IT, above

68 The residue from such, the " superfluity," is called
unhealthy or bad ' humour. This is contrary in capacity to
the former, and is only exceptionally convertible into good
humour. It is proper that it should be expelled from the body
instead. J

w o + ThS familiar P hrase s /' good-humoured," "bad-humoured" of modern con
versation may not have the same significance to the speakers as ?hev had Tn
Shakespeare's day, but retain their value. Y ad 1Q

7 8 THE CANON OF MEDICINE

69. Some of the fluids are primary ; some are secondary.
The -primary fluids of, the body are : the sanguineous

humour, the serous humour, the bilious humour, and the
atrabilious humour.

The secondary fluids of the body are : —

(a) non-excrementitious :

i. located at the orifices of the minutest channels
near the tissues, and thus irrigating them.

ii. permeating the tissues like a dew and capable
of being transformed into nutriment as required.

iii. an almost congealed fluid.

iv. a fluid existent among the tissue-elements from
birth.

(b) excrementitious. " Superfluity." Forms of the re-
spective primary fluids.

70. As regards the non-excrementitious fluids, these
have not yet been subjected to the action of any of the simple
members ; not till they reach the tissues for which they are
destined, are they changed. (j>).

Of the four varieties above named, the second moistens
the tissues according to the requirements which active move-
ments entail, and it comes into play if there is anything likely to
dry up the tissues. The third variety forms a nutriment
which will be changed into the substance of the tissues,
whether to the extent of entering into their temperament,
or to the extent of changing into their very essence, thereby
attaining an entire likeness to the member. The fourth type
accounts for the continuous identity of the member or of the body
throughout life ; it arose with the sperma. It is however true
to say also that the semen (bojJajr^^^
humours.

71. The Four Body-Fluids or Humours Proper.

i. The sanguineous humour, the most excellent
of all.

2. The serous humour.

3. The bilious humour (lit. " red bile ").

4. The atrabilious humour (lit. " black bile ").

72. The Sanguineous Humour.

In nature (that is, considered dynamically) the blood is hot
and moist. In character it either conforms to its nature or it
does not. That is (we may say) it is " normal " or " abnormal."

THE CANON OF MEDICINE 79

Normal " blood " is red in colour, has no unpleasant odour,
and has a very sweet taste.

When blood is abnormal, it is either (a) because the good

temperament has become intrinsically altered or vitiated' ■

i.e. has become colder or hotter ; but not from admixture with
any foreign matter, or (b) because an unhealthy body-fluid is
admixed with it. "This may happen (i) by an unhealthy fluid
corning to it from without, penetrating it and so causing decom-
position in it, or (ii) by a putrescent change in a portion of itself
— the rarefied product becoming bilious humour, and the denser
product becoming atrabilious; either one, or both together, may
remain in the blood. Abnormal blood of type (i) is named
according to (a) that which is admixed with it — whether serous
humour, or atrabilious, or simply bilious fluid. That of type (ii)
is named according to (b) its colour and wateriness — sometimes
it is turbid, sometimes attenuated, sometimes very dark from
much blackness, sometimes pale, (c) taste and odour — bitter,
salt, or sour.

§H7« " Blut ist ein ganz besondrer Saft."

The blood may well be regarded as comprising : sanguineous
humour, corpuscles, the canalicular system of the whole body, and
the tissue-elements abutting thereon ; that is, as including the
lymphatic channels and their floating cellular population. In
addition, there are the blood-forming centres, which are the meeting-
point of two vitalities— the livingness of the blood and the livingness
of the tissues. The hsemopoietic centres are foci disseminating
vital force," as also are the endocrines, the abdominal ganglia, etc.
The energies so well-known as chemical, physical, osmotic, etc.', are
not primary, but conversions from the living force of these centres.
When the blood changes, or its cell-formula changes, it is because the
vital force is changing its mode : instead of radiating in one way, it is
disintegrating in other ways, and it involves some one organ more
than usual. The balance of action on organs, and the balance in
interchange now ceases to be "just," and the organ or organs
concerned therein are then apt to receive the brunt of the physician's
attention.

73. The Serous Humour.

In nature, this is cold and moist. We describe a normal
form and an abnormal.

Normal (" sweet ") serous humour is such as is capable of
transformation into blood at any time, seeing that it is in fact
an imperfectly matured blood. It is a sort of " sweet "* fluid
which is not in too cold a state; that is, it is cold compared with

* We may note that it is still correct to call a discharge " sweet."

8o THE CANON OF MEDICINE

the blood and bilious humour, but hardly at all cold compared
with the body as a whole. } A " sweet " serous humour may
change into one which is insipid, and abnormal, as we shall
describe presently. This happens when there is normal blood
admixed — as occurs often in catarrhal exudates or discharges,

and saliva.

Sweet serous humour (lymph) has no special locus or recep-
tacle in the body, any more than the two bilious humours have.
Yet the serous humour resembles blood closely in this that it is
equally necessary for all tissues, who receive it along with the

blood.

The tissues absolutely require serous humour for two reasons

— one being essential, and the other accessory.

The essential function is two-fold : (a) that it should be
near the tissue (cells) in case they should be deprived of their
habitual nutriment (viz., healthy blood) by reason of retention
of the material in the stomach or liver from some cause. This
material is normally acted upon by the vegetative faculties, which
change and digest it and are themselves maintained thereby.
The transformation of lymph into blood is achieved by the innate
heat. Alien heat would only putrefy the material and decompose
it. This kind of relationship does not obtain in the case of the
two bilious fluids, because neither of them turns into blood at any
time, as the serous humour does, under the influence of the
innate heat ; but they resemble the serous humour in under-
going putrefaction and decomposition under the influence of

" alien " heat.* .

(b) it must be admixed with sanguineous humour before it
can reach and nourish tissues of lymphatic temperament. When
the serous humour is present in the blood for subserving nutri-
tion, it must be in definite proportion before it reaches the parts
to be nourished ; e.g. the cerebrum. It is the same in the case
of the two bilious humours.

The accessory junction is that of moistening the joints and
tissues and organs concerned in movement, for otherwise the
heat of the friction of the movement would produce dryness of
their surfaces. This function is within the range of necessity.

* For "alien heat" we should now read "bacterial infection."

74.
Sweet.

THE CANON OF MEDICINE
Table of Forms of Serous Humour.
i. Normal.

ii. Abnormal

A. — Arranged according to the Taste.

No.

Description.

Sweet.

Salt.

Acid or Sour

Bitter

Insipid.

Remarks.

(i) Outcome of action of the vegetative
faculties ;

(ii) Due to admixture with blood.

Due to admixture with bile, " bilious
serous humour."

(i) Intrinsic in origin ;

(ii) due to admixture with acrid atra-
bilious humour.

(i) From undue infrigidation ;

(ii) from admixture with atrabilious
humour.

Attenuated serous humour.

Temperament.

Hot and moist.

Hot and dry.
Cold and dry^

Cold and moist

B - — Arranged according to Essential Nature.

No.

6
7

9
io

Description.

Watery.

Excrementitious
or Mucilaginous.
Crude.

Vitreous.
Calcareous.

Remarks.

Attenuated serous humour. This may be salty if

there arise m it some sort of putrescence
A superfluity of foreign nature, and evident as such

to the senses as a mucilaginous material.
This is a subvariety of the preceding ; to the senses

it appears to be the same as the preceding but

actually is different. -- 6 '

Glasslike in texture ; taste sometimes sour, sometimes

absent.
Opaque white. Denser than the " crude " form
ihe attenuated part has been dispersed ; that which

is denser than all the others therefore lingers too

long m the foramina and joints.

the same order as the. Latin text, though including all the information therein )

The abnormal forms of serous humour (see also 74).
75. Salty serous humour (No. 2 in table), is warmer, drier
and lighter than any of the others. It is salty because oxidized
earthy matters of dry temperament and bitter taste are admixed
with the watery (nearly or quite insipid) "moisture," in equal
proportions I say "equal " (i.e. in potency, not weight. Tr )
because ii the earths were in excess, the taste would be bitter
rather than salt The same sort of process accounts for the origin
or the salts in all the salty waters found in Nature.

76. Salts may be obtained artificially also, by boiling-
ashes, soap ashes, or chalky matter, etc, in water. Then strain.

82 THE CANON OF MEDICINE

The salt will then separate out from the water, either at once,

or on standing. . rr ...

77 Attenuated serous humour (No. 5, 6) is similar, lnis
may be'insipid or have only a slightly salt taste. This taste
results from the admixture with an equal amount of oxidized
bile, which is dry and bitter ; and the resultant heating
salty fluid is called" bilious serous humour. Though Galen
believed that this kind of serous humour owed its saltiness to
admixture with putrescence or wateriness, my teaching_ is _ that
the putrescence makes it salty by setting up oxidation m it, in
consequence of which an "ash" becomes admixed with the
moisture. Aquosity by itself is insufficient to render serous
humour salty; some other factor must be present, either as well
or on its own account.

78 Serous humour (No. 4) becomes Utter if (1) atra-
bilious humour (which is bitter) be admixed with it, or (11) too
much infrigidation takes place, whereby the taste changes from

sweet to bitter.

The process consists in a congealing and degradation of the
watery element into something dry, and therefore earthy m
character. The degree of heat is too small to ferment it and
make it sour. A strong heat would completely alter it (into
something else altogether).

79 Sour or acid (No. 3). As in the case of sweet humour
there are two forms— one where the sourness is intrinsic m
oriein • and one where it is introduced from without. In the
second'case it is acrid atrabilious humour that is the extraneous
factor We shall speak of it later. When the sourness is
intrinsic, it is comparable with the change that takes place when
the other juices go sour. In other words, it is sour because the
humour has fermented and then gone sour.

80. No. 6. See under No. 2. (No. 7 and 8 are described

in the table.) \ ■ a

81 The vitreous kind of serous humour (No. 9) is dense
and clos'elv textured, and resembles glass in viscosity and weight.
It is sometimes sour to the taste and sometimes tasteless. _

When a humour like this is closely textured and insipid,
it either is " crude," or changes into a crude serous humour
The vitreous humour was originally a watery humour, and
" cold " • and remained so without undergoing putrescence,
or having any other thing admixed with it. All this time it is not
manifest to the senses. It becomes evident only when it thickens
in texture, and develops coldness.

THE CANON OF MEDICINE

3. The Bilious Humour.

In nature this is hot and dry. It also occurs in a normal
and an abnormal form.

82. Natural bilious humour is the " foam " of blood. It
is bright red in colour. It is light and pungent. The redder its
colour the hotter it is. It is formed in the liver, and then pursues
one of two routes— either it circulates with the blood, or it
passes on to the gall-bladder. The part which passes into the
blood-stream subserves two purposes— Q) it enables the blood
to nourish those certain tissues or organs which need the presence
of a suitable amount of bilious humour in a dispersed form : as
holds in the case of the lung, (ii) a mechanical one. It attenuates
the blood (i.e., diminishes its surface tension !) and thus enables
blood to traverse the very minutest channels of the body.

The part which passes to the gall-bladder subserves two
purposes : (111) the removal, in this form, of a certain portion
of the effete matter of the body. In so doing it nourishes the
walls of the gall-bladder.

_ (iv) a dual function {a) it cleanses the food-residues and
viscous serous humour from off the walls of the bowel, (b) it
stimulates the muscles of the (lower) intestine and anus, thereby
enabling them to perceive when it is necessary to go to stool.

83. Any obstruction to the flow of bile from the gall-
bladder through the duct into the intestine is liable to cause colic.

84. Types of Bilious Humour.

Group

Variety.

No.

Description.

Site.

Origin.

Quality.

Normal.

Clear and pure

Liver ; blood

Foam of blood.

Hot.

Abnormal
by ad-
mixture
with alien
substance.

Citron-yellow

Liver.

The alien sub-
stance is attenu-
ated serous
humour
(added to A).

Less hot.

Vitelline-yel-
low, colour of
egg yolk.

Liver.

Dense (coagulat-
ed) serous humour
added to A.

Less hot.

Oxidised bile,
type b. It is
ruddy-yellow,
not transpar-
ent, resembles
blood, but is
tenuous.
Various other
colours may
appear in it.

Liver ; blood

Simple admixture
with atrabilious
humour.

Less de-
leterious
than 4

Oxidised
bile, type a.

Gallbladder.

Spontaneous
Oxidation of
bile = attenuated
part + ash. But
this ash does not
separate out.

deleterious
than 3.

8 4

THE CANON OF MEDICINE

Group.

Variety.

No.

Abnormal
by inter-
nal change
of sub-
stance.

Description.

Hepatic form. Liver.

Site.

Origin.

Leekgreen
bile.
Gastric type a

Mildew or
verdigris
green bile.
Gastric type b

Stomach.

Oxidation of at-
tenuated part of
blood. The denser
part of the blood
separates out as
atrabilious
humour.

Quality.

Oxidation of
vitelline bile.

Mod.
toxic.

Less
toxic.

Intense degree of
oxidation of vitel-
line bile till all
moisture is lost.

v. hot,

extremely

toxic.

No. 7 is possibly derived from No. 6 by an increase in the
degree of oxidation, whereby all the moisture is dried up. 1 he
fact of becoming too dry accounts for the whitish colour For
we know that when heatTs applied to a moist substance it firs
turns black, until all the moisture has vanished, and after that the
bTaSness changes into whiteness. When the .moisture ils ^ ess
than half and half, whiteness begins to be visible Th^.^
s first charred and finally becomes a white ash. Heat apphed ^
a moist body makes it black ; applied to a dry body it makes rt
wSte. Cold applied to a moist body makes it white, and appUed
to a dry body makes it black. _ Such is our opinion about the
Wkp-reen and verdigris-green biles.

g Verdigris-green form of bile is both hotter and more
depraved, aid more deadly than all other kinds of bile. It must
therefore be classed as one of the toxic substances.

The Atrabilious Humour.

85 This is cold and dry in nature. There is a natural
or normal form of this effete substance, and also an abnormal or
morbkl form ^^ ^ ^ ^ „ ^ „ ? or sediment of good

KlooH an effete matter. In taste it is between sweetness and
bitterness. I arises in the liver and then divides into two
portTons, one of which enters the blood, and the other goes to
the ^leen. ^.^ ^^ .^ ^ bl d bserV es two

™;. {a) Intakes parts in the nourishment of those , mem be
which need a trace of atrabilious humour to complete their

THE CANON OF MEDICINE 85

temperament. Ex.-: the bones, (b) It bestows stamina, strength
and density and consistence upon the blood.

88. The portion which passes to the spleen is such as is
no longer of any use to the blood. Its primary use as regards the
body as a whole is that it clears the body of so much effete
matter. ..Its use in regard to one special organ is that it supplies
nourishment to the spleen. Its secondary use is that by travelling
to the mouth of the stomach by a sort of milking movement, {a)
it gives it tone and makes it tighten up and thicken, (b) its
bitterness irritates (tickles) the mouth of the stomach and sets
up a sense of hunger and so arouses the appetite.

89. You must remember that the part of the bilious
.k\LSfiur which passes to the gall-bladder is something no longer
needed by the blood, and that the part which emerges from the
gall-bladder is something no longer needed by that either. It
is much the same with the atrabilious humour. That part
which goes to the spleen is such as is no longer needed by the
blood, and that part which emerges from the spleen is such as is
no longer needed by the spleen.

And besides that, just as the bilious humour, in passing
through the intestine, arouses peristalsis and so helps to get
food away from the stomach, so the atrabilious humour passing
from the spleen arouses appetite and leads to the drawing in of
food down into the stomach.

Wherefore thanks be to Allah the best Artificer of all
things, and unending the praise.

90. The abnormal form of atrabilious humour is not a
sort of precipitate or " faex " ; it is really a form of oxidized
material, or ash formed from an oxidation of the commingled
bilious humour. Thus, when moist things are admixed with
earthy ones, the earthiness separates out (1) as a sediment.
This is exemplified in the case of the blood, of which normal
atrabilious humour is a sediment. (2) as an ash, or oxidation-
product. In this case the rarefied portion disperses and the
dense portion remains behind. This is exemplified in the humours,
of which excrementitious atrabilious humour is the segregate.

91. _ Blood is the only body-fluid which yields a precipitate
of this kind. Serous humour does not do so because of its
viscosity; it behaves like oil. Bilious humour does not do so
because it is attenuated and is deficient in earthy matters, and it is
also constantly moving. This is because the blood separates
out only very little; nothing which needs attention; besides, if a
substance should separate out, it would soon putrefy or be

86 THE CANON OF MEDICINE

expelled from the body. If it putrefied, the attenuated part
would disperse, and the denser part remain behind. It .is this
denser unprecipitated part that is the oxidized atrabilious
humour.

The abnormal atrabilious humour is hotter and lighter than the
natural form, and it has in itself a strong penetrative power of moving
from the upper parts to the lower, and also a destructive action
(Joannitius).

92. Excrementitious atrabilious humour is of four kinds :

(a) the ash derived from bilious humour. This is bitter. The
difference between this and oxidized bilious humour is that m
the latter the ash is only admixed, whereas in the other the
ash separates out after dispersal of the attenuated portion ;

(b) the ash derived from the oxidation of serous humour. The
ash becomes salty if the serous humour is too attenuated and
watery; otherwise the ash is acid or bitter ; (c) the ash derived
from the oxidation of sanguineous humour. This is salty and
faintly sweet ; (d) the ash derived from normal atrabilious
humour. If this humour be attenuated, the ash will be very
acrid, like vinegar. That is, when vinegar (and the like) is
sprinkled upon the earth it " boils " and acquires an acrid odour,
so that flies and insects of all kinds shun it. If the atrabilious
humour were dense the ash will have less acrimony and be only

slightly bitter.

93. There are three kinds of morbid atrabilious humour :■ — ■
(i) Oxidised bilious humour, whereby the attenuated portion
is removed. There are two varieties of this.

94 Injurious Actions. (2) Sero-atrabilious humour is less
injurious and acts at a slow rate. (3) Choleric-atrabilious humour
is more injurious, and undergoes decomposition very readily.

(a) This form is more amenable to treatment than the other.

(b) There is another form which is more acrid, and more in-
jurious. Still, if treatment be begun more early, it will be more
quickly amenable thereto, (c) A third form effervesces less
when dropped upon earth and penetrates the tissues less easily,
and is more slowly destructive. On the other hand it is very
difficult to disperse, or mature or treat by any remedial measures.

• These then are the several kinds of normal and excrementi-
tious humours.

THE CANON OF MEDICINE 87

95. Galen regards the blood as the only normal body-fluid,
for he considers that all others^ are excrementitious and quite use-
less. But if the blood were the only nourisher of the various
organs of the body, it would be as much as saying they are all
alike in temperament and nature. Bone would not be harder
than flesh were it not for the hardness in the atrabilious humour
present in the blood.' Brain would not be softer than the flesh
were it not for the presence in the blood of the soft serous humour
which nourishes the brain. So we conclude that in the blood
there are other humours, which leave it (in the various organs).

96. Moreover, we see how when blood is withdrawn
into a vessel, it contracts and allows various portions visibly to
separate out-^foanaj^the yellow bile), ajtm;bicl^aex.(the atra-
bilious humour), a 2HLlifeS»£gg = 2iii££_j(the' serous humour),
an . d ajraterjJS^T&e aquosityj, which passes out through the
urine. One does not count the aquosity among the body-fluids
because it is not a nutrient, even though it is true it is taken
in as drink. Its purpose is to dilute the aliment and enable it to
permeate the tissues. A humour, on the other hand, is a nutrient,
derived from both food and drink. By the word " nutrient," I
mean that which is assimilable into the likeness of the human
body. — a complex substance, and not a " simple " body. Water,
of course, is a " simple " body.

* * *-

97. Some think that strength of body depends on abun-
dance of blood ; that weakness is associated with paucity of
blood. But it is not so. It is rather this, that the state of the
body determines whether the' nutriment will be beneficial to it
or not.

Others again, believe that whether the humours be increased
or lessened in amount, the maintenance of health depends on
the preservation of a certain quantitative proportion between the
several humours, one to another, peculiar to the human body.
But that is not exactly correct. The humours must, besides that,
maintain a certain constant quantity. It is not a matter of the
composition of one or other humour, but of (the body) itself ;
but the proportions which they bear one to another must also be
preserved.

98. I purposely omit referring to certain other problems
relative to the humours, because they pertain to philosophy and
not to medicine.

Tentatively to draw up correlations between modern biochemical data and the
humours as above described would not be quite a useless exercise. From the
description, it is clear that any given sample of blood contains : (i) all four normal

88 THE CANON OF MEDICINE

humours • (2) a certain proportion of immature humours— that is, under-oxidised
Stive 'products (3) excrementitious humours-the tissue-wastes or effete
substances 5 th ^by-products of complete oxidation. In diseased states, it- may
also contain (4) certain depraved humours, including (a) over-oxidised products;
(h) nutref active substances of various kinds.
(6) putretactiv ^ ejL ardjafc^M^^^

serum-albumen neutrafSt~piS5^ and the salts concerned m maintaining tiieacid-
base equiHbriSm ; * jabSdaJita bilia^umour : ^ig^e^s choig^
and perhaps lecithin " and . v^aMUlite-aadS. I ta^SS&i^gaJuasySffi • neutral
Shlfrnfes^iCaSQSounas-wnen in colloidal form, ^am.-.mufipads,
suipnur & glycogen, animal gum, soaps, various salts To (3) . the

non-J^n-Sli-grlup (urea, ammonta. creatinin, etc.) To (4) : the products
of bacterial °rowth, various auto-intoxications, diamines, etc.
° f b To complete the correlations, some idea should be formed as to the: morphol-
ogical place to which the substances are severally to be assigned, as doubtless the
humou?s occup7blood-cor P uscles and other particulate components of the blood.

2. The Mode of Origin of the Fluids of the Body.

99 Aliment undergoes a certain amount of digestion
during the act of mastication. The lining of the mouth being
continuous with that of the stomach, there is as it were one
continuous digestive surface. When that which has been
masticated comes in contact with it, a certain change at once
takes place in it— namely under the influence of the saliva,
whose action, in virtue of the innate heat within it, is digestive.
That is how it is that when wheat is masticated it procures the
maturation of furuncles and abscesses, but has no such effect
when simply rubbed with water, or even if boiled with water. _

Some assert that the sign which shows us that rood _ is
already beginning to be altered after mastication is that prior
to this act there is neither odour nor taste in it.

100. Once the aliment has entered the stomach, true
digestion goes on— not so much by reason of the heat of the
stomach as by reason of the heat of the enveloping members—

namely :

On the right : the liver. _ .

On the left : the spleen. This not warm in virtue o f its own

substance, but in virtue of its blood-supply.
In front : the omentum, whose fat easily retains heat and

reflects it on to the stomach.
Above : the heart, which warms the diaphragm and so

warms the stomach.

101 The first stage of digestion yields the essence of the

aliment, which, in many animals, becomes " chyle "by the help of

admixture with the fluid which one has consumed. I he chyle

is of the consistence of a ptisan (broth), that is, as thick as sodden

^ C 1Q2 The portion of this chyle which is thus diluted is
drawn from the stomach into the intestines, and then is caused

THE CANON OF MEDICINE 89

to enter into the roots of the mesenteric vessels which are found
all along the intestinal tract. These vessels are slender, and firm.
Having entered these channels the nutriment passes into the
portal vein, enters the gateway of the liver, and then travels
along finer and ever finer divisions until it comes to the capillaries
(lit., the very fine hair-like channels), which are the ultimate
sourse of the vena cava emerging from the convexity of the liver.

The passage of the nutriment through these very narrow
channels could not take place were it not admixed with water
consumed in excess of the strict requirements of the body.

By being distributed over the whole liver in this way, the
chyle is exposed to the digestive function of the whole organ,
and the function of the liver is thus accomplished most vigor-
ously, energetically, and speedily. The change of nutriment into
blood is now complete.

103. The various products and by-products of digestion
up to this point may be tabulated as follows (p) :

Table of Digestive-products.

(a) In healthy digestion —

(i) the blood itself,
(ii) By-products :

(a) a foam . . . . . . . . the bilious humour.

(b) a sort of precipitate the atrabilious humour.

(b) In unhealthy digestion —

(iii) By-products :

1. Attenuated portion .. .. morbid bilious humour.

2. Dense portion . . . . morbid atrabilious humour.

(d) A product when digestion is not

carried far enough . . . . serous humour.

104. As long as it stays in the liver, the blood which the
liver forms is more attenuated than it should be, because the
wateriness is in excess, for the reason already given. But when
the blood leaves the liver the excess of water is removed, for it is
taken to the renal vessels, and so provides the kidneys with the
quantity and quality of the blood best suited for their nutrition.
The " fat " of the blood nourishes the kidneys, and the super-
fluous wateriness and a certain degree of sanguineous material
passes down to the bladder and so away from the body.

105. The good blood ascends into the superior vena cava,
and its subsequent course is into smaller and smaller veins :
and finally into the finest hair-like channels. Having reached
these hair-like channels it " sweats out " through their orifices
and bathes the tissues, according to the decree of Allah.

9 o THE CANON OF MEDICINE

106. Table' of the Causes of Humours.

Name of
Cause.

Blood.

Bilious
Humour

1
Serous
Humour.

Atrabilious
Humour.

Material
Cause.

Those parts of
the solid and
fluid aliment
which are of
equable tem-
perament.

The" attenuated
hot, sweet, oily
and sharp by-
product of ali-
ment.

The dense hu-
mid, viscid, cold
by-product of
the aliments.

The very dense
by-product of
the aliments,
very deficient in
moisture, and ex-
ceeding in heat.

Formal
Cause.

Exact and good
digestion.

Digestion verg-
ing on excess.

Imperfect
digestion.

Pre'cipitati ve
tendency, pre-
venting the flow
or dispersal.

Efficient
Cause.

Attempered
heat.

Attempered
heat, for nor-
mal bilious hu-
mour ('■ foam ').
Undue heat, for
abnormal bili-
ous humour.
Site: liver

Feeble heat.

Medium heat ;
i.e., a heat of
oxidation which
surpasses the
limits of equi-
poise.

Final
Cause.

To nourish the
body.

Primary :

nutrition ;

attenuation of

blood.
Secondary :
cleansing bowel
wall ; desire for
stool (see 82).

Primary and
Secondary pur-
poses named in
73.

Primary and
secondary pur-
poses named in
87.
Nutrition.
Inspissation of

blood.
. Nourishment of

spleen.
Tone to stom-
ach.
Aid to appe-
tite.

107. Further details regarding the efficient causes :
i. Action of heat and cold. One must not forget that the
most fundamental agents in the formation of the humours are
heat and cold. When the heat is equable, blood forms ;
^hSTheaTis in excess^ bnipus^h^mo^r jorjm; when in great
excess, so thlToxidation occurs, &hllmm„]m££^$S^
When the cold is equable, ser^^Jmrnour^ forjns,,,.; when cold .
is in excess, so that congelation becomes dominant, atrabilious

humour forms. . .

II The faculties. There is also a proportionate relation
between the active and passive faculties (which has to be con-
sidered in thinking of the formation of the humours).

III. The temperaments. One must not get the idea that every
temperament gives rise to its like and never to its_ opposite. A
temperament often gives rise to its exact opposite, indirectly

THE CANON OF MEDICINE 91

(of course) ; it cannot do so directly. A cold and dry
temperament may give rise to visible moisture, though this
would not be beneficial, but would indicate that, the digestion is
feeble. A person with such a temperament would be thin, with
supple joints, and hairless skin, cold to the touch, the surface
veins narrow, and he would be gentle and apprehensive (timid)
in nature. He would be like the old person, who makes too much
serous humour and is cold and dry in temperament.

108. Circumstances which make the atrabilious humour
■plentiful.

(1) Immoderate degree of heat in the liver.

(2) Weakness of the spleen.

(3) A degree of cold sufficient to be congelative and cause
marked and long-continued constriction.

(4) The existence of various long-standing or often repeated
diseases whereby the humours are reduced to ash.

When the atrabilious humour is plentiful, it lodges (not
literally, but virtually) between the liver and stomach, with the
result that the formation of blood and healthy fluids is interfered
with, and less blood is formed.

109. Third digestion. — The blood and that which circulates
with it undergoes a third digestion in the blood-vessels.

This is a truth worth noting. The tissue-foods carried by the blood, and the
tissue wastes discharged into it, undergo treatment within it, which is only efficient
if certain salts and acid bases are present ; otherwise conversion of such substances
into available form fails to occur ; and deposition in various tissues, fascia, and
joints, and even in the vessel-walls (atheroma, e.g.) and nerve-sheaths occur with ill
effect. These deleterious substances may be thought of as composed of particles
too large to permeate the (" invisible ") pores of the tissue-boundaries referred to,
and the pathological condition of " obstructions " which looms so largely in the
Canon here finds its raison d'etre.

110. Fourth digestion. When the nutriment has reached
the various members, giving each its appropriate " element,"
a fourth digestion takes place.

111. The fate of the residues. The residues from the first
digestion (namely that in the stomach) — pass out by way of the
intestines as excrement. Those from the second digestion
(namely, in the liver)- — pass out chiefly by the urine, though
some go to the spleen and gall-bladder. The residues from
the other two digestions are discharged partly by the skin as
insensible perspiration and external sordes ; partly through
visible orifices — the nostrils and ears ; partly through the invisible
orifices scattered over the whole body ; sometimes through

92 THE CANON OF MEDICINE

unnatural channels' in the form of inflammatory matter ; some-
times as appendages like the hair and nails

If the body-fluids become attenuated, they are readily
dispersed and discharged from the- body, especially when the
pores dilate. The loss of such fluids produces great weakness,
not only by the fact of the loss but also by the dispersion and loss
of breath which (necessarily) occurs simultaneously

112 Lastly, it must be clearly understood that not only
the causes of origin, but also the causes of movement of the
humours must be taken into consideration.

Exercise and heating agents set in motion the sanguineous
humour, the bilious humour, and even the atrabilious humour
(which is strengthened thereby). Repose sets the serous humour
in motion and strengthens it. Repose also strengthens some
kinds of atrabilious humour.

Even imagination, emotional states and other agents cause,
the humours to move. Thus, if one were to gaze intently at
something red, one would cause the sanguineous humour to
move. That is why one must not let a person suffering from
nose-bleeding see things of a brilliant red colour.

" Wer iov, and oassions of a like nature are accompanied
by a change in the body." (Sum. Theol. 75,3! P- ". trans.)

The temper of a cow frequently determines the quantity of the
milk it yields, if it gives milk at all. But under the influence of such
passions as anger, rage, fury, the milk changes m quality, and
develops noxious or poisonous properties. Even the flesh may
become poisonous if the animal suffered intensely or protractedly
either mentally or physically. Overdriven cattle may thus yield meat
which contains toxic substances injurious to the human consumer
(Lindasy, 48 ii. 270, etc.).

Effects of colours on bodily functions.-^ and yellow are

injurious to_the eye. ^^}M,^^^S£jmmB^^^^^
"wfeTed lighlstlmulaterrr^ Morning light aids nutrition. Colours
vary in their effect according to their intensity. Conversely, dark-
ness benefits various conditions ; it helps to induce inactivity and
sleep (Pereira 152 ; Babbit 151 ).

Li-ht in another sense has an effect on the emotions : for instance, the light
of intelligence converts fear (earth element) into caution, affectum (water element)
into benevolence.

113 This completes all we propose to say at present about
the humours and their mode of formation. There are other
aspects of the subject whose discussion and justification pertain
to the philosopher.

(See also the composite Chart at the end of the Volume.)

THESIS V. THE MEMBERS

i. What- a Member is and what are its Components

114. The members of the body are derived primarily
from the commingling of the humours, just as the humours are
derived primarily from the commingling of the aliments, and
the aliments are primarily composed of commingled " elements "

115 There are simple members and compound members
I he simple members are those whose structure is homogeneous
throughout, so that their name describes them in all parts •
e.g. flesh,_ bone, nerves, and the like* The compound members
are those m which one and the same word is not a correct descrip-
tion of all the parts. For instance, in the case of" hand " " face "

"v? T" ^ e ^ iS u n0t " faCG " ; a P art of the h ^ d is not
hand. Ihese members are called " instrumental " because

they are the instruments whereby the passions and actions of
the mind ( soul ") are achieved.

Table of the Members.

Auxiliary Organ
Afferent

Principal
Organ

Sense Organs Lung

Immediate

Auxiliary Organ

Efferent

Remote
Auxiliary. Organ
(Elementary

Tissues)

BRAIN

(Animal
breath)

Nerves

V
HEART

(Vital
breath)

Arteries

Stomach

AND

Intestine
Veins

LIVER

(Natural
breath)

Constituents of
Humours

V
REPRODUCT-
IVE GLAND

V v

Gall-bladder, Ducts and

Spleen, Kidney Genital Adnexa

V v

Bones, Cartilages, "\
Ligaments, Muscles, I " Flesh
Fasciae, Tendons, | Fat
Membranes I

Intestinal
Tract

parts.

Equivalent to the modern term Element,

ary tissues. Cf. " homoi

lomenous '

94 THE CANON OF MEDICINE

116. The Simple Members (the " elementary tissues.")
"Simple": Cf. the' scholastic sense— homogeneous ; in-
divisible. (See § 19.)

i . The bone. This is sufficiently hard to form the founda-
tion of the body as a whole, and provide the purchase needed for

its movements.

2. The cartilage. Being softer than bone, this can be bent,
and yet it is harder than all the other members. It was made for
the purpose of providing a cushion between the hard bone and
the soft members, so that the latter should not be injured when
exposed to a blow or fall, or compression. This is shown m the
case of the shoulder-blade and the bones over the praecordia,
and the ribs ; and in the case of the epiglottis and xiphisternum.
In the case of joints, it prevents the tissues from being torn by
the hard bone. It gives a purchase for a muscle to obtain ex-
tension in places where there is no bone to give attachment or
support (for instance the muscles of the eyelids), and also gives
attachment to muscles without being too hard for them (for •
instance, the epiglottis). _ .

3. The nerves. These are structures arising from the brain
or spinal cord. They are white, soft, pliant, difficult to tear, and
were created to subserve (a) sensation, (b) movement of the

limbs. . .

4. The tendons. These form the terminations of the
muscles. They resemble nerves in appearance. They are
attached to movable members, and when the muscles contract
and relax, the parts to which the tendons are attached move to and
fro. "They may sometimes broaden when the muscle expands,
and then become narrow again on their own account, lengthening
and shortening apart from the lengthening and shortening of the
muscle. Sometimes this is through the intervention of ligaments.
The upper part of the muscle is called " flesh " ; that which
"leaves the flesh and passes to the joint, bringing the two close
together, is the " tendon."

5. The ligaments. These structures have the appearance
and feel of nerves. They are of two kinds : true and false. The
latter extends to the muscle. The former does not reach as far
as the muscle, but simply joins the two ends of the bones of a
joint firmly together. This false ligament has not the feel of
ligament, and is not painful when moved or rubbed. The
auxiliaries of the ligaments are the structures attached to them,
as has been explained.

"IT

THE CANON OF MEDICINE 95

6. The arteries. These structures arise from the heart.
They are hollow, elongated,, fibrous, and of ligamentous con-
sistence. _ Their movements consist in expansion and contrac-
tion, which distinguishes them from the veins. They were
created in order to enable the heart to be ventilated, fuliginous
vapour to be expelled therefrom, and the breath* distributed
by their means to all-parts of the body.

7-_ The veins. These resemble arteries except in so far as
they arise from the liver and do not pulsate. Their purpose is
to carry the blood away from all parts of the body.

«,* Jit 3 /* 16 *+? ftf^ wTl^T^ r6ad " t0 a11 P arts of the bod y-" As we know,
the belief was that blood left the heart to all parts of the body, and also left through
the veins to all parts of the body. The arteries carried the breath. The veins
earned the aliment. The heart therefore drove blood away from it on both sides
the distribution into minute capillaries was known for both series of vessels But it
did not seem to occur that the two flows were in opposite directions, and that as much
went out of the heart as came into it. The conviction that the two quantities were not
ITt + T aS f real r eason f ? r n °t going on to the truth of the literal circulation
At bottom, it was the equality of the two quantities which Harvey had to prove
in order to establish the fact of the circulation.) P

8. The membranes. These structures are formed of
extremely minute interwoven filaments which are extremely
delicate. Their object is {a) to form the external covering for
other structures and thereby (b) preserve the form and outline
of these structures, (c) to support the members, (d) by means of
their fibres to bind together the nerves and ligaments with the
members ; for instance they hold the kidneys in position, (e) to
impart sensation to members which are themselves insensitive,
since by providing a sensitive covering they enable the member
to be aware of anything befalling it. For instance : the lung,
the liver, the spleen, the kidney ; all of which are in themselves
insensitive^atjdjg^^ werTtHare not a

^Hl e SbBae,oyerJ:hjm,t_ A flatulent distension or an inflammatory
deposit in the organ is felt by us only because the enclosing
membrane, being stretched, feels it ; or, in the case of an
inflammatory mass, is aware of the weight.

9. The flesh. " Flesh " includes muscles, fasciae, tendons,
ligaments, connective-tissues, and so forth all together. Flesh
is that_ which fills up the spaces left within the members, thus
imparting firmness and solidity.

117. In every member there is a natural faculty (the
vegetative faculty) which subserves its own- nutrition. This

* Nowadays we would say " oxygen *' instead of " breath "
their ^erfton^TcovelS ("" ***** "* ^ ^^ to ' tou <* *** ^ ™

9 6 THE CANON OF MEDICINE

faculty is the power by which attraction, retention, assimilation,
union with nutriment, and expulsion of effete matter are secured.
Members may therefore be classified accordingly. But besides
that, some members possess a further faculty which passes from
them to another member, while others have not sucha faculty.
Other.. members again have still another faculty which passes
into them from another member, and some have not such another

faculty.

The following associations may therefore be assumed : —
(a) receiving and also giving a faculty.
{b) giving and not receiving. a faculty.

(d) neither giving nor receiving a faculty.

118. There can be no doubt about the existence of the
first-named. All agree that the brain and the liver each receive
their power of life, natural heat, and breath from the heart, and
that each of them is also the starting-point of another faculty
which it sends out to other organs. But there is a disagreement
about the second. Thus in the relation betweenthe brain and
sensation, is sensation confined to the (literal) brain, ornot ?_ In
the relation between the faculty of nutrition and the liver, is it
integral in the liver, or not ?

119. Then, too, in regard to the heart. There is a great
disagreement between the philosophers and the physicians. The
great Philosopher said that the heart is a member which gives
and does not receive ; that it is the first root of all the faculties
and gives the faculties of nutrition, life, apprehension, movement,
to the several other members, — whereas physicians (and some
of the ancients) considered these faculties to be distributed among
several members (the faculty of nutrition in the liver ; of vital
power in the heart ; the mental faculties in the brain) ; and that
hence there can be no such thing as a member giving without
receiving. However plausible the physicians are, careful con-
sideration shows that the argument of the Philosopher is much
nearer the truth.

" There are the minds of the cells of the liver, and the liver-mind— the mind
that regulates the activities of the liver-cells. Above the liver-mmd and above
the stomach-mind and the heart-mind is the general physical mind ; and, above that
general physical mind, and also above the intellectual mind is a higher mind still.
There is a hierarchy and kingdom within us." — (Miles, 135 , p. 92).

120„ As to the third association, we consider that there
can be no doubt about the fact that some members receive and
do not give. Thus, the flesh receives the power of sensation and
life, but has not the power of imparting another faculty in return.

THE CANON OF MEDICINE 97

121. As to the fourth — there is also a disagreement both
among physicians and among philosophers. On the one hand
it is thought that the non-sentient bone and flesh and the like
could not continue to live unless these powers were residing in
them, and that therefore they do not need to receive ; — that the
power provided by the aliments conveyed to them is adequate,
and that therefore they neither furnish a power for another
member nor does another member furnish them with a power.
The opposite opinion is that the powers in those members are
not residing in them, but are formed in the liver and heart ;
and when they reach these members, they come to rest within
them. There is no means of deciding between the two views
by argument but the inability to do so is no hindrance in practice.
As to the first of these two views, one must realize that it does
not matter whether the heart be the source of sensation and volun-
tary motion in the brain, or not ; whether the source of the
nutritive faculty be in the liver, or not. It is of no significance
whether the brain has in itself the source of the powers of the
soul, or whether these powers only come by way of the heart.
In any case it is only a relation. If the liver is the starting-point
of the nutritive faculty, that too is only in relation to other
members.

Then as to the second of the two views, one must realize
that it does not matter whether the natural faculty in a member
like bone is innate in it in virtue of its temperament, or whether
it arose in the liver first, or whether neither is true. One must ■
rather realize that the faculty could not be there at all were it
not for the liver, and that therefore if the path were obstructed
the bone would cease to receive the necessary nutriment, and
its functions would cease — exactly as holds in the case of move-
ment when some nerve-connection with the brain is severed.
There is the natural faculty in the bone as long as its tempera-
ment is maintained.

122. The whole discrepancy is removed by regarding
some members as principal or vital, some as auxiliary, and some
as neither vital nor auxiliary.

123. Classification of Members into Principal (or, Vital)
and Auxiliary.

The principal (or, vital) organs are those in which the
primary faculties of the body arise- — i.e. the faculties necessary
either to the life of the individual or to the life of the race.

" In thej body is a part which being sound the rest is sound, and which being
unsound, the rest is unsound. And this is the heart." (Burton : Night 80).

9 8 THE CANON OF MEDICINE

The principal organs necessary for the life of the individual

are three in number : . . . ,

'i—The heart, the source or starting-point ot the vital

power, or innate heat. , „ , • .- a

Y 2 __The brain, the seat of the mental faculties, sensation and

movement. . . . c u -

3 — The /iw, the seat of the nutritive or vegetative faculties.

The organs concerned in the maintenance of the life ot the
race are : the three just named, and :

,__The generative organs, some of which are essential and
others auxiliary. The essential, function is that of forming
generative elements ; the auxiliary functions are those ot
giving the masculine and feminine form and temperament.
These functions are inseparable from the race, and yet play no
part in the essence of life. _

The aa^/wry members are of two kinds : (a) preparative,
(^ purely or absolutely auxiliary. The former come into
operation before the principal members can come into play.
The purely auxiliary members come into operation after the
principal members have functioned. This is conveniently shown
in the following table :

Preparative member.

Lung.

Stomach.

Liver, with other nutri-
ent members and the
guardians of the
breath.

Testis or ovary.

Member subserved.

Heart.

Liver.

Auxiliary member.

Aorta.

Brain.

Generative organs.

Veins.

Nerves.

Penis and erectile tis-
sues (and ducts.)

Female organs car-
rying the semen to
the site of concep-
tion. Uterus as per-
fector of the virtue
of the semen.

* These are the " adnexa.

THE CANON OF MEDICINE 99

124. Classification of the members according to action.-—
Galen classified the members into those which effect an action
(e.g. heart), those which assist the action (e.g. lung) and those
which achieve both (e.g. liver). But for my part, I consider as
" action " that particular kind of action by means of which a given
member accomplishes the maintenance of the person's life or
the perpetuation of the species. Thus, the heart gives rise to
the breath. Action is assisted when one member is prepared
for receiving the action of the other member, thereby completing
the process either of giving life to the individual, or of propagating
the race. Thus, the lung prepares the air. The liver carries out
the first digestion so far as to prepare for the third and fourth
digestion. The more perfectly the liver functions in regard to
the second digestion, the more likely is the blood so made to
be adequate for nourishing the tissues. Hence in this respect
the liver effects an action ; and, in so far as the liver assists in ac-
complishing a further action, so it is preparative for that action.

125. Classification of the members according to their origin. —
Some members take their origin from the semen : namely,

members composed of like parts, except the flesh and the fat.
Other members come from the blood : namely the flesh, and the
fat. Other members come from both male and female "sperm."*
According to the teaching of philosophy, the process of genera-
tion may be compared with the processes which take place in the
manufacture of cheese. Thus the male " sperm " is equivalent
to the clotting agent of milk, and the female " sperm " is equiva-
lent to the coagulum of milk. The starting point of the clotting
is in the rennet ; so the starting-point of the clot " man " is in
the male semen (" We made the life-germ a clot "■ — Q.23.14).
Just as the beginning of the clotting is in the milk, so the begin-
ning of the clotting of the form of man lies in the female " sperm."
Then, just as each of the two — the rennet and the milk. — enter
into the " substance " of the cheese which results, so each of the
two — male and female sperm — enters into the " substance "
of the " embryo."

* The word " Sperma " is here really more exact than " semen."
Semen = x + sperm. Therefore it is not incorrect to speak of a " female sperm."
Note that only a portion of the spermatozoon enters into the new human being,
and not all the ovum.

Paracelsus wrote that the " sperm " is not the visible seminal fluid of man,
but rather a semi-material principle contained therein, or an " aura seminalis,"
to which, the semen serves as a vehicle (De generatio hominis : Hartmann, «, p. 72).
In another place he says " the matrix attracts the seed of both persons, mixed with
the semen, and afterwards expels the semen, but retains the sperm. Thus the
seed comes into the matrix. The matrix does not merely mean the womb of a
woman ; the whole body of the woman is a mother, a matrix." — (De morbo. matric).

ioo THE CANON OF MEDICINE

Galen gives a contrary account. He considers that each of
the sperms has both a coagulative power and a receptive capacity
for coagulation ; so he says that the coagulative power is stronger
in the male than it is in the female, but the receptive capacity
for coagulation is stronger in the female than the male.

But the real truth of the matter is expounded in our own
works dealing with the fundamental principles of natural science.

126. Relations between the jemale menstrual blood and the
embryo.

i. During pregnancy, the blood which is otherwise dis-
charged from the female at the time of menstruation becomes
nutriment (for the embryo) in three ways. One portion is
changed into the likeness of the substance of the sperm and the
members derived therefrom. This is the nutriment which
enables growth to take place. Another portion is not nutriment
of that kind, but is capable of being aggregated into the material
which fills up the interstices in the principal members and
becomes flesh and fat.

A third portion is effete material, and not utilizable for
either of the two preceding purposes. It remains in the same
situation until the time of birth, and is then expelled with the

infant.

After birth, the blood which the liver of the infant makes
takes the place of the maternal blood. So it arises from an organ
which itself was formed out of the maternal blood.

127. The flesh of the infant is derived from the gross
blood, congealed by heat and dryness [cf. the fact that a moderate
degree of heat coagulates' egg-white]. The fat of the infant is
derived from the aquosity and unctuosity of the blood, which
cold has congealed and heat dispersed.

128. Repair of damaged members. — {a) Members derived
from the sperm.

Should a loss of continuity arise in the members derived
from the sperm, restoration can only occur, and then only in a few
of them, and if the individual is spare in habit, and has not passed
the age of juvenility. These members are : the bones, the small
branches of veins ; medium-sized veins and arteries. For when
disseverance occurs in such members as bone and nerves, they
will not grow again.

(b) Members derived from the blood.

If the members which are derived from the blood are
damaged, they are renewed out of like substance. E.g. the flesh.

THE CANON OF MEDICINE 101

If the member which is damaged arises both from blood
and sperm, then, as it is not very long since the sperm was there,
it will be reconstructed (Ex.; the teeth at the age of juvenility)
unless meanwhile the blood has undergone a change of tempera-
ment. In that case re-construction would not take place.

129. Sensation and movement is sometimes conveyed to a
member through one single nerve, sometimes through several
nerves. In each case the nerve is the source of the power.

130. The membranes which cover the internal organs. ■

These all arise either from the pleura or the peritoneum. Those
members in the thorax, which derive their covering from the
pleura, are : the diaphragm, the veins and arteries ; the lung.
These organs in the abdomen are covered from the peritoneum
which covers the muscles of the abdominal wall.

" • * ' * r

131. Texture of members. All members are either fleshy
in texture or fibrous (like the flesh found throughout muscles),
or are devoid of fibrous texture (e.g. liver). Fibrous texture
goes with power of movement. — voluntary in the case of voluntary
muscles ; involuntary in the case of the uterus and veins. Com-
pound movements, like that of deglution, depend on the direction
of the fibres being various. — longitudinal, oblique, transverse.
The longitudinal fibres produce in-drawing ; the oblique fibres
expel or force onwards ; the transverse fibres grip and hold.

Even where a member has only one coat, as is true in the
veins and bladder, there are still three kinds of fibres which inter-
weave one with another. Members which have two coats have
the cross fibres externally, and the others on the inner side.
The longitudinal fibres tend towards the inner surface. The
purpose of this arrangement is that in-drawing and expulsion
should not occur simultaneously, whereas there is no objection
to the acts of in-drawing and holding and gripping occurring
together— except in the case of the intestines, where much
retention is disadvantageous, whereas in-drawing and expulsion
are all-important.

132. Hollow (tubular) members which contain substances
different from their walls have sometimes one coat, sometimes
two. The presence of two coats serves the following purposes :

(i) to provide the necessary strength to the Walls, so that
there is no risk of the proper power of movement failing at any
time. Ex.: arteries.

io2 THE CANON OF MEDICINE

(2) to ensure that the contents shall not dissipate or escape.
One coat would, not suffice to retain so tenuous a substance
as the breath which the arteries contain ; and it would make the
risk of rupture or severance in injuries too great, m which case
death would be very liable to occur because the blood would then
drain out.* This is a very great danger.

(3) where there is a demand for vigorous suction and ex-
pulsion, it is beneficial to have a separate instrument available
for the performance of both actions rather than to distribute both
powers over the one coat. This applies in the case of the stomach
and intestines.

(4) where each coat of a member subserves its own action ;
or each action requires its own particular temperament. Thus,
in the case of the stomach, there is a need of a power of sensation
(which can only exist in a tissue containing nerves) and also a
power to execute the movements of digestion (for which a fleshy
tissue is needed). Hence each need is supplied by its own coat—
the nerve-containing tissue for the power of sensation ; the
fleshy coat for the power of executing the movements entailed
in the work of digestion. Nature made the inner coat capable of
sensation, and the outer coat fleshy. The operation of sensation
requires actual contact with the nervous tissue, as is true m the
case of the sense of touch ; but the movements necessary to enable
digestion do not require contact of the material to be digested
with the fleshy walls.

133. Certain members (e. g. the flesh) have a temperament
so near to that of blood that the latter needs to undergo little
change in order to subserve nutrition. Consequently there is
no need for apertures or for spaces or cavities in these members,
wherein to retain nutrient material pending its transformation
into their own substance. In such members the nutrient at once
becomes identical with their substance.

134. But other members (e.g. the bones) have a tempera-
ment which is very different from that of the blood. Therefore
before these can be nourished, the blood must needs undergo a
series of successive transformations before becoming like tothem
in substance. That is why spaces were made in which nutriment
can be retained long enough to enable the conversion to take
place. This is true in the case of the femur and humerus. In the
case of the lower jaw bone numerous apertures are seen scattered
through it. In this way more nutriment can be accommodated

* Note this proof that Avicenna knew the arteries contain blood.

THE CANON OF MEDICINE 103

than is necessary for the moment, and the transformation into
their own likeness can take place little by little.

135. Lastly, strong members expel their waste matters
into the adjacent weaker members. Thus the heart to the axilla ;
the brain to the tissues behind the ears ; the liver to the groins.

§ i_i8. The next four subsections of the text are omitted. They
deal with the anatomy of the bones, muscles, nerves and blood-
vessels, and are naturally inadequate in comparison with modern
Anatomy.

Ancient anatomy has been criticized for allowing as a basis the dissections',
of monkeys and other animals, apparently overlooking the important factor of
circumstance, m order to give the impression of lack of acumen in those days But
in our days, ability and acumen being taken for granted, it is considered allowable
to base conclusions m the domain of physiology and pathology upon laboratory
reactions obtained from the same kinds of animals. Some workers are alive to the
possible insufficiency of data so obtained, but make a virtue of necessity This
may also be claimed for Avicenna.

Avicenna was seeking to express a certain truth in these sub-
sections as well as in other parts of the Canon, and it is profitable
to abstract it and develop it further in the light of modern knowledge.
The following are some of the considerations in mind.

§119. The variations of anatomical structure which are
observed throughout the animal kingdom are the expression of the
differing nature and requirements of the respective animal-types.
But in dealing with comparative anatomy it is usual to regard
evolution as the essential factor, and a false meaning to the phenomena
is thereby instilled. We speak of animals as " higher " and " lower "
for convenience, but strictly all are equal, because " each creature
has such perfection as it was possible for it to have." (St. Thomas, 82
p. 108), and its place is in accordance with the " end " for which it was
brought into being, the word " end " bearing the scholastic sense.
The proper use of the theory of evolution in comparative anatomy, like
that of Ehrhch's theory in regard to immunity, is that it enables
many discrete facts to be memorized. To raise either to the dignity
of truth " necessitates an overlooking of the fundamental properties
of the nature of being.

120.

Deformities. These may be explained on an evolution-
ary basis, using the ideas of " reversion," " atavism," etc. When the
individual is studied in regard to his " end " (in the scholastic sense)
a different conception comes to light. But as this brings in the
question of events belonging to the category of morals (" to the third
and fourth generation "), the problem is at once evaded. Such a
conception would not be vitiated by the existence of deformities
among animals.

121.

- The intimate structure of the body is always changing

although the anatomical structures appear to remain unchanged.

io 4 THE CANON OF MEDICINE

Hence it is possible to see in these structures' merely a locus for the
various faculties and functions pertaining to the physical, mental
and emotional life of the individual. Compared with his existence
in the scheme of things, the anatomical details are mere " moments
musicales."

To take a special example,, one might regard the blood-forming centres as the
(momentary) point of meeting of two vitalities. (Cf. §147.)

§ 122. Relation between structure and function. This formed
the subject of a classic in medical literature — that in which Galen
regards' anatomy as the expression of the 4>va-i,s. Such a teleo-
logical view is not in favour to-day, and, indeed mistakes (as
Galen did) the root principle emphasized in these pages. To use the
symbolism given in § 56, 64, M is not the " expression " of F. In
associating structure with function this must always be remembered.
The examples available for Avicenna, striking as they seemed to
him, are surpassed by those possible through modern knowledge.
Thus, harmonious succession of events, both in time and place, is to be
discerned throughout the body. The output of the various digestive
juices, separately achieved, yet co-ordinated as to time is also
co-ordinated as to place. The output of bile, for instance, is fitful—
sometimes a delicate trickle, sometimes in spurts, sometimes m larger
quantities ; and this in co-ordination with the activity of the muscular
bundles beneath the membranes which secrete the digestive fluids—
in which both nervous and vascular variations play an intimate part.
Out of many other instances, the following may be given. The-
adrenal vein joins the inferior vena cava at a given point, in order to
secure that the adrenal secretion shall enter the blood in time to
receive the activating substances supplied for it by the liver before
it becomes exposed to the oxygen contributed by the respiration ;
for otherwise the activation would be nullified. (Cf. Sajous 149 .)

§ 123. Transcendence of organs, fluids, and the like, beyond
anatomical boundaries. — This has already been referred to in the
opening chapter. Thus (a) "heart" includes the arterial system
and something more; "liver" includes the venous system and
something more ; " brain " similarly goes beyond the organ within
the cranium to the cutaneous nerve-endings. This is why a " function
test " for a given organ is never satisfactory, (b) Vascular channels
and tissue spaces are simply demarcations of fluids from adjoining
tissues. The river exists because there is water to flow, and in-
cidentally is an " anatomical feature " of the country,serving various
purposes. Its presence is the indication of, and continues only as
long as, certain incessant changes occur in Nature at large. To use
other words, the vascular channels are the materialization of the
stream of blood ; or, the current of " life " made the blood-vessels
become demarcated. (c) The humours of the body circulate also in
the subtle fashion suggested thus : the sanguineous humour is not
only in the blood vessels but also in lymph channels _: the serous
humour moves in the connective-tissue spaces as well as in anatomical
lymphatics, and appears also in the form of the " eau de constitution "

THE CANON OF MEDICINE 105

(Vallery-Radot 141 ) of ■ the tissues : the bilious humour may be
followed in the track of cholesterin (and other constituents.) The
constant loss of hair, nails, teeth, should also be recognized as being
part of the constant separation of " superfluities." (Cf. Paracelsus 29 ).
(d) If we realize that tissue-spaces and cavernous tissues are forms of
channels, it will be clear that the whole body is really an aggregate
of " tubes .'.' of some sort. It may then be said further, that disease
always starts from tubes, — namely when their lumina are blocked or
when their " walls " become semipermeable or quite impervious.

§ 124. Anatomical structures depend for their existence on
chemical structure. Water, for instance, may be said to come into
visibility in the form of an anatomical structure. Conversely, other
substances are only visible as long as they are not yet an integral part
of the living substance of the body, and others are visible because
they have ceased to be such.

As soon as microscopic visibility is attained, the visible thing
has ceased to be " living." Stability of form entails the stagnation
of certain substances, and also implies that they have been rejected
from the cycle of life in order to provide the substrate or platform or
points d'appui for the actual living substance (i.e., the life-principle) to
manifest its faculties during a certain (often limited) period of time.
Cf. § 121.

§ 125. Histology (i.e. microscopic anatomy) and function.
From the preceding consideration, when a tissue is observed through
the miscroscope, the thought should be " that is the spot where this
or that substance has emerged into visibility at this moment." This
conception is specially applicable to the case of the blood-cells.

Cf. § 95-99-

§ 126. Anatomy as the expression of strengths and weaknesses.
It is clear that the relative development of different parts of the body,
from head to foot, reveals its physical strengths and weaknesses.
Where one part is strong, another is compensatorily weak. But it is
less obvious, and less realized, that anatomical conformations are also
revelations of strengths and weaknesses of mental make-up. Here
also, the strength of one feature goes with deficiency of some other.
The root principle of jelal and jemal already referred to (§ 82) holds
good throughout, and in a multitude of directions. Mental
capacities and activities affect the vegetative processes just as do the
emotions, for their influence lasts throughout life. As S. Thomas
says : (a) " every operation of the sensitive soul belongs to the
composite " (S.T., 75, 3, 84 p. 10). (b) " There are certain operations
common to the soul and the body, such as fear, anger, sensation, and
so forth ; for these happen by reason of a certain transmutation in a
determinate part of the body, which proves that they are operations
of the soul and body together " (C.G., ii. 57, 82 p. 139). (/) " We
find in the intellective appetite, which is the will, operations specifi-
cally similar to those of the sensitive appetite, differing in this, that in
the sensitive appetite they are passions, on account of its connection
with a bodily organ, whereas in the intellective appetite they are pure
operations. For just as by the passion of fear which, in the sensitive

io6 THE CANON OF MEDICINE

appetite, one shuns a future evil, so without passion, the intellective
apoetite has a like operation " (ib., 82 90, p. 190).

" § 127. From all this it is clear that much is to be learned from
external anatomy (head, face, hands, joints, skin markings, etc.) as
to the strength and weakness, not only of the body as a whole, but of
the several organs in particular. Were the study of internal anatomy
combined with the external, the associations would be more appre-
ciated. The "case" is not really finished when a "handful" of
viscera has been studied in the autopsy-room or even in the labora-
tories attached thereto. The remaining "shell" passes on into
oblivion bearing its wonderful secrets with it, for its language is such
that however loudly it " speak," there are few with ears to hear, and
perhaps none with ability to interpret.

THESIS VI
The Faculties of the Body

.„ " LlFE appears through various operations in different degrees of living things "
(S. Thomas, S. Th. q. 76, art. 1). ■ 06

1. General Discourse about the Several Kinds of Faculty

gl^' ACULTIES (136) are to be distinguished from

^ zj functions. The difference is that the former

originate the latter. But as each function depends

on its own special faculty they can be treated together.

Faculty : the name of a property whereby the phenomenon of life is mani-
fested. Function : actualized potentiality.

Faculty =power =potentiality. Faculty is not force ; it i s potential power ; it
is static. Power is the faculty in a state of activity ; it is dynamic.

The tout ensemble of faculties is " the soul."

The tout ensemble of functions is " life." See § 150.

Weakness of faculty corresponds to " hypof unction." Plethora of faculty
corresponds to " hyperfunction ".

137. There are three kinds of faculty, and therefore of
functions proceeding therefrom. Namely, the vital (haywaniat) ;
the natural [taby 'yat) and the animal (nafsaniat).

§ 128. These three terms, derived from the Latin version, only
properly express the meaning of the Arabic if they are taken in
their original sense. The third term is rendered " psvchical " by
some translators, 163 but is open to objection because' its modern
usage does not sufficiently correspond to the idea of nafsaniat.

Other words are preferred in the course of the present trans-
lation. The familiar " vitality " is convenient for the first term.
The words " vegetative " and " sensitive," employed in the
Dominican translation of the Summa, 8 * are satisfactory renderings
for the other two terms, and are to be understood strictly in the
Thomistic sense. The term "natural" is reverted to in 551 for
reasons there given.

The variations in scope exhibited by these and allied terms are
conveniently indicated in the following table.

107

io8

THE CANON OF MEDICINE

§ 129. Analysis of certain Terms applied to living things : — i.e., Beings

ENDOWED WITH " LlFE."

Vegetable.

Animal.

Human.

I. Distinctive

quality. •
1 . In Modern

Vegetative.

Sentient.

Rational ; intellec-

language.

Organic.

(Lower) mental

tual, Higher men-

powers .

tal life, Psychic

Organo- vegetative

powers.

(Martinet)

2. Platonic term.

Nutritive.

Appetitive.

Rational.

3. In Avicenna. 5

Vital.'

Natural. '

Animal. 5

Ratiocinative

faculty.

4. Scholastic

Vegetative (life or

Sensitive "(life or

Rational (life or

terms.

soul).

soul).
Sensuous
(Necessarily im-
plies " appeti-
tion," 84 78, i. p. 78)

soul).

II. These terms are

based on —

.(a) the faculties

pertaining to each
(i) Pre-modern

Plants have only

Animals have also

Human beings have

thought.

nutrition, growth,

sensation and

also intellect or

and reproduction.

movement.

intelligence.

(ii) Modern

But modern re-

But some animals

But this is not so

thought.

search (cinemato-

exhibit intellec-

for some races of

graph, etc.) shows

tual powers often

men, and in some

sensory and mo-

supposed to be

cases of disease of

tor powers.

purely human.'

the brain.

(iii) In terms of

Unconscious life.

Subconscious life

Fully conscious life

Consciousness.

and lower con-
scious life.

(6) On essential
manifestations

As " nature."

As sensation.move-

As capacity for ab-

" breath"'

ment, and cogita-

stract concepts.

(3. Avicenna).

tive power.'

Effected by means

Is effected apart

tal causes.

of a corporeal

of a corporeal or-

from a corporeal

(4. Scholastic

organ, in virtue of

gan, but not in

organ or quality.

basis.)

a corporeal qual-
ity.

virtue of a qual-
ity.
Deals with parti-
culars.

Deals with univer-
sal 81 (78, i. p.

(d) on theological
considerations.

78).

Mortal.

Immortal : {a) ab-

solutely (Scholas-

tic view) ; (6) con-

ditionally (some

creeds).

III. Chief organ
concerned.
1. In modern

All vegetative - or-

Nervous system

Brain (Grey matter

thought.

gans equally im-
portant (Bio-
chemical process-
es in general).

(automatic and
central) .

of cortex.)

2. Platonic.

Liver.

Heart.'

Brain.

3. Avicenna.

Heart. 8

Liver (and Gonads)

Brain.

4. Scholastic.

All viscera. '

Nervous system,

No material organ.

No special organ

but also the whole

because " life "

" being."

belongs to all.

THE CANON OF MEDICINE ic 9

Notes on points arising out of this table :

1 Boundaries of the Three Kingdoms : — These are admirably set out in Chahar
Maqala 7 : "When the vegetable kingdom was produced, God' gave it the four forces
and the three faculties. When the animal kingdom was produced, God added
two more faculties— that of perception (with five external senses and five internal
senses), and of movement. When the human kingdom was produced, God added
a capacity for abstract concepts (intelligence)."

2 Ayicenna's division : this is determined by medical requirements.

3 Vital faculty. — This is not specifically mentioned bv S. Thomas, because
implied in the word " life." He refers to it thus : " The vital operation .
whereby something is shown to be living " 84 (liv. 2. p. 44). " Life-principle " has
a wider scope than implied in " vital faculty " : — " The vital principle is the ' form '
or determining principle of the living being. Coalescing with the material factor it
constitutes the living being. It unifies the material elements into one individual.
It holds them together ... as a mass of chemical compounds, many of them
most complex and in very unstable equilibrium, constantly undergoing change and
tending to dissolution into simpler and more stable compounds. W ; hen life ceases,
the process of disintegration sets in with' great rapidity. The function, then, of
this active informing principle is that of a unifying, conserving, restraining char-
acter, holding back, as it were, and sustaining the potential energies of the organism
in their unstable condition." — (Maher 17 , p. 427).

1 Natural faculty.— i.e., " pertaining to the .' nature.' That is, (a) the mere
fact of living at all, (b) powers in common with laws of Nature in general. Compare
the term "natural science," " natural philosophy " (used before the present era)
applied to the modern chemistry, physics and their subdivisions. The ancients
recognised that physiological phenomena in regard to the " natural " life were
kin to those of our chemistry and physics.

Note also the meaning of " nature " in : "the natural appetite is that in-
clination which each thing has, of its own nature, for something. Wherefore by
its natural appetite each power desires something suitable to itself." 81 (p. 78).

5 Animal faculty. — The word "animal" really denotes simply "a thing
with an anima " ; hence man is an animal. But different people among all nations
use the word (in their own language) entirely vaguelv, and thus give rise to perennial
confusion of thought when applying it in daily life. The following meanings are
assigned to it :

(i) Generally or collectively, it refers to the presence of life : e.g., anima-te ;
in-anima-te.

(") ( Specifically or particularly, (a) indefinitely as (a ') " soul " (a") " mind "
{a"') "spirit" (quaecumque substantia invisibles " 83 — i. 41, 3, 4). (b) More
definitely = 4>vxv = lower soul, as opposed to animus, the higher soul, whose seat
is the " heart," the centre of cognitive and emotional life. 17 (xiv. 153). See Si so
1.51. ' x 3 '

6 Manifestation as " breath " ; or, by means of the breath. See § 161. Breath
= spiritus, which is defined by S. Thomas as " an instrument of the soul, tenue,
lucidum, calidum, ex puriore sanguine" (i. 41. 3. 4). cf. preceding note, under
" spirit."

7 S. Thomas recognized such powers in animals : " Cogitative and memorative
powers are not distinct, but the same, yet more perfect (in man, that is) than in other
animals." 84 (78. i. p. 90).

8 The heart. — In the platonic view it is the chief organ of the appetitive soul ;
in Avicenna it is that of the breath. See §§ 136-141. But this would make the ap-
petitive soul equivalent to the vital faculty, which it is not. Another objection

■ to the platonic view is explained by S. Thomas 82 (p. 145).

_ § 130. " Only three powers or parts of the soul are commonly
assigned — namely, the i^g^He_soul, th^^n^rivg^ouj^and^thi^
-a 3li£nal_joul. . . . There are five generaTof powers of "th'e^soul —
the vegetative, the sensitive, the appetitive, the locomotive, and the
intellectual^ Of these, three are called souls, and four are called
modes of living." . . . The reason of this diversity lies in the various
souls being distinguished accordingly as the operation of the soul
transcends the operation of the corporeal nature in various ways ; for

no THE CANON OF MEDICINE

the whole corporeal nature is subject to the soul, and is related to it as
its matter and instrument. There exists, therefore, an operation
of the soul which so far exceeds the corporeal nature that it is not even
performed by any corporeal organ ; and such is the operation of the
rational soul. Below this, there is another operation of the soul,
which is indeed performed through a corporeal organ, but not through
a corporeal quality, and this is the operation of the sensitive soul ;
for though hot and cold, wet and dry, and other such corporeal
qualities are required for the work of the senses, yet they are not
required in such a way that the operation of the senses takes place
by virtue of such qualities : but only for the proper disposition of the
organ. The lowest of the operations of the soul is that which is
performed by a corporeal organ, and by virtue of a corporeal quality.
Yet this transcends the operation of the corporeal nature ; because
the movements of bodies are caused by an extrinsic principle, while
these operations are from an intrinsic principle ; for this is common
to all operations of the soul, since every animate thing, m some way,
moves itself. Such is the operation of the vegetative soul; for
digestion and what follows is caused instrumentally by the action of
heat, as the Philosopher says."— Sum Theol. 83 Q. 78, art. 1 :
Trans., 84 p. 75, 76.

138. Many philosophers, and all physicians who follow
Galen, consider that each faculty has its own principal member,
which forms its storehouse, and from which its functions emerge.
On this view the rational faculty resides in the brain, and its
functions proceed from the brain. (Cf. § 130).

139. The natural or vegetative faculty is twofold, and in-
cludes (i) the nutritive faculty, which is concerned with the welfare
and preservation of the individual, and secures nourishment to
it to the end of life. This faculty resides in the liver, and its
functions emerge therefrom, (ii) the reproductive faculty, which
ensures the propagation of the race. This subserves the process
of generation, and separates the substance of the sperm from the
humours of the body and fashions the new body according to the
decree of Allah. The seat of this faculty is the generative organs,
and its functions proceed from them.

140. The vital faculty preserves the integrity of the
breath, and is the vehicle of sensation and movement, and makes
the breath able to receive these impressions (of sensation and
movement), and, having reached the brain makes it capable of
imparting life, and then spreads in every direction. The seat
of this faculty is the heart, and its function proceeds from this.
(See 162-167).

141. Now the great philosopher Aristotle believes that
the heart is the source of all these functions, though they are

THE CANON OF MEDICINE m

manifested in the several" principal organs. But physicians still
keep to the opinion that the brain is the chief seat of sentient
life, and that each sense has its own distinct member whereby
it manifests function. But if physicians thought over the whole
matter as thoroughly as they should, they would take Aristotle's
view_ instead. They would find that they have been only re-
garding appearances instead of realities, taking non-essentials
for essentials. (Cf. 119, 165). The establishment of this truth
is for the philosopher and natural scientist, and not for the doctor
as doctor. But the latter, looking on members as being initiators
of the faculties instead of as their manifestation — thus despising
or ignoring philosophy— fails to see which things are prior,
and accordingly overlooks the proper basis for the treatment of
diseases, and for the remedying of bodily defects (p).

" There i s in the body no one beginning, but all parts are alike beginning and
end ; for a circle has no beginning." (Hippocrates)-.

I 12

THE CANON OF MEDICINE

2. The Natural Faculties

142. The natural faculties are divisible into two groups :
(a) dominant or directing, .(b) subservient or obedient.

The dominant faculties are twofold : (i) concerned with the
preservation of the life of the individual ; — the nutritive faculty
and the augmentative faculty (power of growth), (ii) concerned
with the preservation of the race : — the generative faculty ; and
the formative or plastic faculty.

i3i-

Classification of the Natural Faculties.

General
purpose.

Dominant

faculty

(hadima)

Subservient

faculty

Khadama.

Synonyms.

Quali-
ties.

Element

Corres-
ponding

Mental
process.

: /

d '■■
o

'-£ i
'C j

-t-> !

3 :
pi

O
m

Nutritive -g
(ghazia) B (
(143) "g S

3 !

o
xi

: \

i. Attractive
Jadhiba
(147)

Apposition.

Presentation

Prosthesis.

Hot and
dry.

Fire.

Percep-
tion.

ii. Retentive
Masika (148)

Agglutinative

Adhesion.

Prosphysis.

Cold and
dry.

Earth

Memory.

The
Individual

iii. Alterative

Hadima

(149)

Transforma-
tive.

Assimilative-
poietic

(e.g. haemo-
poietic).

Hot and
moist.

Air.

Cogitation

iv. Expulsive
Dafi'a
(150)

Propulsive
Expeditive.

Cold and
moist.

Water

Expres-
sion.

Augmenta-
tive
(namia)
(143)

Auxetic.

Plastic.

Incremental.

Acquisi-
tion

of know-
ledge.

The Race.

Generative
(muwaliida)
(145)
(i) in the
strict sense
(2) primary
transforma-
tive faculty
(mughayyara 1

The mascu-
line factor.
(Tr.)

Aether

Creative
and Inven-
tive facul-
ties.

Informative
(masawwira)
(145)

Plastic.
Operates in
utero. The
feminine
factor (Tr.)

Construc-
tive
faculties.

THE CANON OF MEDICINE 113

143. The faculties pertaining to the preservation of the life
of the individual.

The nutritive faculty is that whereby the aliments are
transformed into the likeness of the thing nourished, thereby
replacing the loss incidental to the process of life.

The augmentative faculty is that whereby the increase in
size of the body in" all directions in just proportion is secured.
This is brought about by means of the substances derived from
the aliments. The nutritive faculty is subservient to this
augmentative faculty in so far as it enables the preparation of the
requisite substances from the aliments, but growth will not occur
unless more is supplied than is lost. However the supply of
more substances than are lost does not necessarily produce
growth. Growth implies an increase in all directions in the
proper proportions. To become fat or obese with advancing
years, after being slim, is not growth. It is not growth unless
the increase is in all dimensions and in natural proportions,
so as to culminate in a state of perfection of growth. Adiposity,
for instance, is not a perfection of growth before adult age,
any more than it is a perfection for the figure to be very slim after
maturity to a greater degree than natural.

144. There are three special functions in the process of
nutrition, (i) the apposition of the altered material, namely,
the blood, or a humour which is potentially like the tissue to be
nourished. If this process is defective, as may happen in disease >
there is " atrophy," which is a defect of nutrition, (ii) agglutina-
tion' — a later stage. Here the nutriment apposed to the tissue
is now fully united up to it, and made a part of it. This may be
lacking owing to disease, and then occurs what is called " fleshy
dropsy." (iii) true assimilation — a stage still further where that
which has been made into a part of a member becomes absolutely
like it m all respects, in essence and colour. This fails in such
conditions as leprosy and vitiligo, in which cases the first two
functions are achieved, but not the third.

These three procedures are the work of the transformative
power. This is really a single faculty, though distributed among
the respective members. For in every member this faculty is
corresponding to its temperament, and so transforms the aliment
into the likeness (ad-similis) of that member ; in each case it
differs from that which transforms aliment into the likeness of
the various other members (or tissues). So (we may say) the
transformative faculty of the liver ramifies throughout the whole
body.

ii 4 THE CANON OF MEDICINE

145. The faculties pertaining to the preservation of the race. — ■
The generative faculty is two-fold, (i) That which gives rise to the
male and female " sperm," the reproductive units, (ii) the forma-
tive power (i.e., in the male element) which separates from one
another the various faculties in the sperm and rearranges them in
such a way that each member (and tissue) receives the tempera-
ment appropriate to it— thus, to nerve, its distinctive tempera-
ment ; to bone, its distinctive temperament. The one " sperm,"
apparently homogeneous, opens out in all these directions. This
is called the primary transformative faculty.

The informative or plastic j : acuity (lit. as in making a sculpture
painting) is that (in the female element, Tr.) whereby, subject or
to the decree of Allah, the delineation and configuration of the
members is produced, with all their cavities, foramina, positions
and relations to one another, their smoothness or roughness, and
so on' — all being controlled up to the final limits of their natural
growth (dimensions). Subservient to this faculty, in regard to
that part of the nutriment which serves for the preservation of
the species, are the nutritive faculty and the power of growth.

§ 132. From the annotations by Costaeus : reproduction implies a plastic
faculty ; and that implies transformative power, and that depends on the four
qualities. Growth cannot occur without nutrition ; nutrition cannot occur without
agglutination or assimilation ; agglutination cannot occur without apposition ;
assimilation cannot occur without transformation ; transformation cannot occur
without retention ; and retention cannot occur without affinity. Each successive
step entails the removal and excretion of the products and by-products of the
preceding steps, for these are hindrances to reproduction, nutrition and growth.

3. The Faculties Subservient to the Natural Faculties

(Vegetative Life)

146. Vegetative Life (i.e. the natural faculties) is sub-
served by four faculties : attractive,* retentive, transformative,t
expulsive.

147. The attractive faculty was created so that the body
could draw to itself whatever nutriment is required for its
preservation. The longitudinal fibres in an organ form the
instrument used for the purpose. The liver attracts the chyle
from the stomach by sucking, as it were, the purer parts thereof
by way of the mesenteric veins.

148. The retentive faculty was made so that the material
so drawn in could be held (in position) during the time that the

* The word attractive, in the original, is primarily with the thought of the
attraction of (female) beauty and has a peculiarly appropriate application in
consequence.

■f " Ferment " actions of the body belong here.

THE CANON OF MEDICINE u 5

alterative (transformative) faculty is engaged in preparing sound
nutritive substances from it. The instrument employed for this
are the oblique, and in part, the transverse fibres. (In the case
of the_ liver, the chyle is retained in it long enough to enable the
sanguificatory power to act upon it.)

149. The alterative or transformative faculty is that which
alters the material attracted and held by these two powers. It
transmutes the material from its former state until it has become
worked up into a temperament such as enables it to become
efficient nutrient material. This process is " digestion '-' in the
strict sense.

At the same time it produces a change in the superfluities
so that they can be easily discharged from the member containing
them. This process is called " maturation." By its means three
things happen : (i) — the texture of the superfluities becomes
attenuated, when it is inspissation that hinders expulsion ;
(2). — the texture of the superfluities becomes thickened, when it is
attenuation that prevents their discharge ; (3) — the superfluities
are entirely broken up, if it be viscidity that hinders expulsion.
It is a mistake to use the terms " digestion " and " maturation "
as synonymous.

150. The expulsive faculty is that whereby the superfluities
from digestion are expelled. Superfluities are such as are
unsuitable as nutriment, or are in excess of requirements (and
therefore " superfluous "). By means of this faculty, the waste
matter is expelled into the bladder as urine, and other excreta
through their several appropriate organs and apertures. Where
there are no orifices, the wastes are transferred by this faculty
from noble to less noble organs ; from hard structures to soft
ones. And if there is a diversion of waste matter from the proper
route, the expulsive faculty cannot remove as much as otherwise.

151. Inter-relations between the faculties and the qualities. — -
These four natural faculties are subserved by the four

primary qualities — heat, cold, dryness, moisture. Strictly
speaking, heat is the underlying factor in all the subservient
faculties.

152. Action of cold. — While cold aids all four faculties
it does so indirectly and not directly — except in so far as
it is the contrary of all the faculties. For all the facul
ties act in virtue of movement, which is shown not only as
attraction and expulsion, but even in the transformative
process (digestion proper) ; for the latter consists in the
separation of gross and aggregated particles from one another,

n6 THE CANON OP MEDICINE

and in the condensation together of the finer and separated
particles. The movements of dispersion and aggregation
are simultaneous. Movement is also concerned indirectly
in the retentive faculty, because the transverse muscular
fibres come into play. Coldness enfeebles, stupefies, and morti-
fies, and hinders this faculty in all its functions ; yet, indirectly,
it helps it by fixing the fibres in the position referred to._ There-
fore it is not directly concerned with the faculties ; it simply
causes their instruments to be in a state which will help their
functions to be maintained.

Coldness aids the expulsive faculty (i) by preventing the
dispersal of the gases which favour peristalsis, (2) by keeping the
particles of the aliment coarse, (3) by its astringent action upon the
transverse muscular fibres. In these ways coldness renders the
instruments of the faculty in an appropriate state. Evidently,
then, it only helps the faculty indirectly. Did it act directly, it
would obstruct and weaken the movements.

153. Action of dryness. — Dryness is directly instrumental
in the functions of two faculties. — namely the alterative and re-
tentive. It is auxiliary in the case of the other two— the attractive
and expulsive. This is because dryness delays the movement of
the breath, enabling it to take on with it those faculties which it
has encountered with a vehement impact. It also prevents the
moisture present in the substance of the breath or its instrument
from flowing away. Dryness helps the retentive faculty because
it favours (muscular) contraction (i.e. upon the contents of the
organ). The transformative faculty needs moisture (and not

dryness).

154. Comparative relations between the qualities and the
j 'acuities. —If one compares the degree of active and passive
quality requisite for the various faculties, one finds that the
retentive faculty needs more dryness than heat. This is because
more time is required for a movement to come to rest than is
needed to start a contractile movement of the transverse fibres.

155. Heat is necessary for movement, and it takes only a
short time to produce its effect, so that the remainder of the time
is occupied in holding the material and coming to a state of rest.
This explains why the temperament of juveniles tends to moist-
ness, for their digestive power is weaker.

156. The attractive faculty needs more heat than dryness
because the chief feature of attraction is movement, and move-
ment demands heat. The organs concerned must move rather
than be at rest and contracted (for which dryness is needed).

THE CANON OF MEDICINE 117

Not that much movement is required for this faculty, though at
times violent activity becomes necessary. Attraction is brought
about (a) by an attractive faculty — as when a magnet attracts
iron, (F) by heat, as when oil is drawn up in a lamp. — Some
physicists assert that the last-named is really an example of filling
up of a vacuum.

Heat increases the power of the attraction exerted by the
attractive faculty.

157. The expulsive faculty requires less dryness than the
attractive and retentive faculties, because there is not the need
of the muscular contraction requisite for retention, nor for the
apposition necessary for attraction ; nor a need to maintain
contraction upon an object until the next stage of the process
is reached. Nor is there a need for repose ; but, on the contrary,
there is a need of movement, and also a small amount of inspissa-
tion — -just enough to ensure that degree of compression and
expulsion which is necessary to make the contracted viscus an
instrument. Lastly, whereas the retentive faculty requires a long
period of time and the attractive power only a short period —
namely that necessary to bring one thing in contact with another —
so there is less need of dryness.

158. The transformative faculty requires more heat than
the other three. It does not need dryness but moisture, for by
moisture the nutrients are rendered fluid and so become able to
enter the pores and become moulded into the conformation of the
channels to be traversed. But one must not suppose that because
moisture aids digestion, juveniles (whose temperament is moist)
can digest hard or indigestible foods. This can be done in
youth, but here the reason is not to be found in their moisture ;
it is because at that period of life the "nature" is similar to that
of the foods in question. Foods of hard nature are not appropriate
for the juvenile temperament (which is - soft), and therefore their
transformative faculty cannot cope with such food ; their
retentive faculty cannot hold it, and their expulsive faculty rapidly
expels it. In the case of youth, on the other hand, such hard food
is quite suitable for nourishment.

n8 THE CANON OF MEDICINE

159. The following brief .table gathers together these
points :

Attractive Faculty.
Retentive Faculty.
Alterative Faculty.
Expulsive Faculty.

Duration of muscular
contraction.

Quite short
Long ; continued.
Continued.
Momentary.

Amount of longitudinal
movement achieved.

Marked.
Moderate.
None.
Considerable, but

superadded from

without.

The alterative faculty needs liquefaction and commingling

of substances.

160. So the various faculties make use ot these tour
qualities in diverse ways and to different extents.

si« Thus, the attractive faculty is not equal in degree in all organs. Heat
is stronger in the liver than in the stomach and intestines, m arteries than m veins
The livfr at one time is hotter (and therefore the attractive faculty is greater) than
It another So also in the case of the stomach. Hence if the stomach is empty
and the liver is hot, the stomach will draw out the serous humour ^le from the
liver Tust as a strong person can take something out of the hands ot a weak
plrson if he wants to, or, on another day, the weak person is the stronger* (Cf.
Galen, Daremberg, ls ii. p. 3°7)-

" The operation of the vegetative principle is performed by means of heat,
the property of which is to consume humidity."— (Sum. Theol." 75, P- »i-)

4. The Vital Faculty.

161. The power which the members receive before they
can acquire the capacity for the faculties of sensation and move-
ment, and for accomplishing the various functions of lire, is
called the "vital faculty." Closely related to this (subject) is
(that of) the " breath," and therefore also of the emotions of
fear and anger, because they coincide with the expansion and
contraction of the breath, (/>.)

8 1 34. Vital faculty = virtus vitalis = vitality = innate heat ==
" spirits " (corporeal, vital, natural, animal) = breath (which is its
manifestation) = Spirit = " refined form of bodily substance or

* There is a striking parallel to this passage in the " It'ung cheng mo " (circa
ad 10.56) on page 25 of the subdivision " Mo Chueh Chih Chang : referring
to the changing dominance of the types of " breath " in the various organs per-
ceptible by a study of the pulse. The author states : " it is just hke the case of the
Hng of Wu, who obtained the supremacy over the dominion of Chu, and then ne-
Sected his own defences. The king of Yu seized the advantage of his unprotected
state, and in turn obtained the possession of his territories.

THE CANON OF MEDICINE n 9

fluid believed to act as a medium between mind and the grosser
matter of the body." 1 ? (xv. 220) = " a kind of very subtle body
which penetrates all parts of the material body and infuses them like
the essence of a rose, oil in sesame, butter in milk " (Motazelite view 13 )

Cf. § 118, § 136; and see 167-173.

In part it corresponds to " life principle," and also in part to
"substantial form." But it is not the " soul " ; it is one of the powers
of the soul ; the soul is a " bundle of life " ; i.e., a bundle of faculties
and powers which complete the material body. Soul: body::
vibration : atom.

162. We now proceed to enlarge this brief statement.
On the one hand there are bodies of dense substance. — the organs
and tissues — which are derived from the dense particles of the
humours of the corresponding temperament ; and on the other
there is the " breath," derived from the rarefied attenuated
particles of the humours of corresponding temperament.

163. Physicians regard the liver as the seat of manufacture
of the dense part of the humours, and the hearts that of the rarefied
part. Really speaking, as soon as the breath and the appropriate
temperament meet, the vital power comes into being, and thus
all the members are rendered capable of receiving all the other
faculties (of the soul) — sensitive and otherwise. The sensitive
faculties do not appear in the breath and members until this vital
power has come into being, and so even should the sensitive
faculties in a given member be lost, life will remain in the part
until the vital power has forsaken it. Does one not find in prac-
tice, how a limb is devoid of sensation from paralysis (whether
as^ a result of 2. temperament which renders it incapable of re-
ceiving sensation or showing movement, or because of some
obstruction to the current from the brain and nerves into the
limb) yet continues to live ? and does one not find that a limb
which has lost the vital power loses also sensation and movement,
dies, and undergoes putrescence and decomposes ? That shows
that the power which renders a member living is still there even
in the paralysed member, so that sensation and movement would
return again, could the obstruction be removed. In fact, the
intact possession of this vital power makes the limb always
ready to receive the attributes in question. That which obstructs
these attributes does not interfere with the power of receiving
vital breath ; the member itself is not dead.

Further, it is not the nutritive faculty that prepares a member
for receiving sensation and motion. It is not the nutritive
faculty that is fundamental for the life of a member. One cannot
say that a member perishes as soon as the nutritive faculty is

120 THE CANON OF MEDICINE

abolished. The statements just made about a paralysed limb
apply equally to the nutritive faculty. For sometimes the
nutritive faculty ceases in a member and still the member
continues to live. Sometimes the nutritive faculty is unimpaired
and nevertheless the member tends towards death.

Then again, if it be the nutritive faculty which provides the
power of sensation- and movement, should not plants also share m

these powers ?

164 Hence it is clear that there is something else preparing
(the members for these powers), something akin in temperament
to itself— and this something is the vital faculty. This is that
faculty which appears in the breath at the very moment at which
the breath develops out of the rarefied particles of the humours
As the philosopher Aristotle says, from that moment the breath
receives its first beginning and all the other faculties flow out
from it. Not that the activities of these faculties are directly
derived from the breath, any more than the sensation (as doctors
agree) proceeds from the animal breath in the bram until the
serase-impression has passed the crystalline lens, or the tongue
or the other sense-organs. It is when the particular portion ot
the breath reaches the appropriate parts of the bram that it
becomes impressed with the temperament of the bram and there-
by becomes adapted for the operations of the faculties proceeding

from and reposing in it. , j .•

The same applies in the case of the liver and reproductive

organs. , . ^1

165 The opinion of physicians differs from this. Iney
state that unless the temperament of the breath becomes altered
in the brain the breath is not capable of responding to the soul
(anima, nafs), the source of sensation and movement. But they
admit that the initial temperament of the breath plays a part in
enabling it to receive the primary vital faculty. The same thing
holds for the liver, and other principal members. From this
point of view, however, there would have to be a separate soul
(anima) for every kind of action; the soul would have to be really
an aggregate of various souls, instead of being one single agent
from which the several faculties emanate.

6nt. Scholastic argument against such a conclusion.—" If
man is to be understood as three or two (souls) using a body, it
follows that man is not one thing, but two or three for he is three
souls or at least two. And if this be understood of the intellective
soul only, so that the sensitive soul be understood to be the body s
form, and the intellective soul, using the animated and sensified
body, to be a man, this would again involve absurdities, namely that

THE CANON OF MEDICINE 121

man is not an animal,. but uses an animal ; and that man does not.
sense but uses a sentient thing. And since these statements are
inadmissible, it is impossible that there be in us three souls differing
in substance, the intellective, the sensitive, and the nutritive."
(S. Thomas 82 p. 144).

If the primary temperament helps the breath to receive the
primary faculty, then the vital powers, the breath and the
faculties are hs perfection. The primary vital faculty is not
sufficient by itself to enable the breath to respond to the other
faculties, but needs an appropriate temperament first. The
physicians also claim that this faculty, besides paving the way
for "life," itself initiates the movement of the attenuated
spiritual substance (the breath, that is) towards the various
members (organs), and is the agent which brings about the con-
traction _ and expansion of ■ respiration and pulse. In that it
assists life it is " passion " ; in that it assists the activity and
functions of mind and pulse it is " action."

166,, _ The vital faculty resembles the natural faculties in
that its actions are beyond the scope of the will. It resembles the

animal (sensitive) faculties in carrying out contrary actions ■

namely, it dilates and contracts at one and the same time, effecting
two contrary movements at once.

167. The diverse use of these terms in philosophy and
medicine. — When the ancients use the word " soul " (nafs),
they refer to the earthly or corporeal soul, the perfection of the
corporeal body, which is its instrument ; the source of all those
faculties upon which the movements and various bodily opera-
tions depend. The natural faculty, in medicine, thus corresponds
to the " animal " faculty in philosophy. The soul (nafs) is not
understood in this sense but is " the power which originates
understanding and voluntary movement." The natural faculty,
in philosophy, means " every faculty from which any bodily
function proceeds." But this is not the "animal faculty"
of medicine but a natural faculty of a higher order than that
named " natural " in medicine. So, if natural faculty is defined
as " that which is concerned in nutrition whether for the preserva-
tion of the individual or of the race," then another, and third
term would be required to represent this other faculty. Anger,
fear, and similar emotions are passions of this same faculty'
and admittedly arise from the senses, the judgment and the
apprehensive faculties.

The proof of the existence of this third faculty, and of its
being single or multiple, is a question for natural science, which
is part of philosophy.

122

THE CANON OF MEDICINE

Expressed in another form,
Term in Philosophy

Corresponding term

in Medicine
Scope of term

Corporeal Soul

( = lower reason)
Animal Faculty

Seat of movement,
action, operations

Natural Faculty

(Higher) natural

Faculty
Seat of passions
and starting point
of ' apprehension.'

Animal Faculty

Natural Faculty

Vegetative
Functions

The important subject of the "breath" needs further elucidation at this
point The conWty oAhe ■■ Canon" is therefore here interrupted by introducing
?he opening passage of " De viribus cordis," and an explanatory extension.

THE BREATH
Its Origin, Forms, Sources, and Relation to the Being

168.

I. THE ORIGIN OF THE BREATH.

•J created the left side of the heart,
A and made it hollow in order that
'~"J?Lj& it should serve both as a store-
house of the breath and as the

seat of manufacture of the breath. He also
created the breath to enable the faculties of the
^ " soul " to be conveyed into the corresponding
f^^^l members. In the first place the breath was to
t^==^ be the rallying-point for the faculties of the soul,
and in the second place it was to be an emanation into the
various members and tissues of the body (whereby these could
manifest the functions of those faculties).

169. Now He produced the breath out of the finer particles
of the humours, and out of igneity ; and at the same time pro-
duced the tissues themselves (the visible body) out of the coarser
and terrene particles of these humours. In other words, the
breath is related to the attenuated particles as the body is related
to the coarser particles of the same humours. Just as the
humours are intermingled to produce a temperamental " form,"
whereby the members of the body are enabled to receive a physical
appearance, impossible were they separate ; so the attenuated
portions of the humours, being intermingled into a temperamental
form, enable the breath to receive the powers of the soul —
impossible were the humours separate.

170. The beginning of the breath is as a divine emanation
from potentiality to actuality proceeding without intermission
or stint until the form (lit. preparation, state) is completed and
perfected. Each member, though derived from the self-same
substance of the humours, nevertheless has its own particular
temperament— for the proportional quantities of the (denser

123

i2 4 THE CAN0N 0F MEDICINE

portions of the) humours and the form of their commixture are
peculiar to each member. Similarly, although derived from
the same attenuated portions of the humours, nevertheless
each of the three breaths, (natural, animal and vital) has its own
particular temperament, for the proportional quantities of
the more attenuated portions of the humours, and the manner
of their commixture are peculiar to each breath.

171 . Although the body consists of several members, there
is one from which they all originally arose. As to what this
member actually was, there are various opinions. The fact
remains that one member necessarily came to light before other
members could arise out of it/ Exactly the same is true
in the case of the breaths. There is one single breath which
accounts for the origin of the others ; and this breath, according
to the most important philosophers, arises in the heart, passes
thence into the principal centres of the body, lingering m them
long enough to enable them to impart to it their respective
temperamental properties. Lingering in the cerebrum it receives
a temperament whereby it is capable of receiving the faculties
of sensation and movement (sensitive faculties); m the liver, it
receives the faculty of nutrition and growth (vegetative
faculties) ; in the generative glands it acquires a temperament
which prepares it for receiving the faculty of generation (re-

172. The foundation or beginning of all these faculties
is traceable to the heart, as is agreed upon even by those philoso-
phers who think that the source of visual, auditory and gustatory
power lies in the brain.

173. Some philosophers consider that the breath is made
able to receive these faculties, and so be perfected, in other
members (than those named). Thus, visual power results from
the union of the temperament of the breath with the moist
temperament of the crystalline lens ; that the auditory power
results from the union thereof with the temperament of the
auditory nerve ; that gustatory power is produced by the
mediation of the moist temperament afforded by the soft
spongy sub-lingual glands.

Others reject this view and consider that the breath carries
the faculties from the brain, and receives nothing from the
temperament of the member to which it travels, as nothing is
necessary to perfect it. The member itself is an instrument well
adapted for the action of the vegetative faculty, and contributes
nothing of its own essence.

THE CANON OF MEDICINE

125

Other philosophers have claimed that the breath acquires
all its powers in the heart, emerging therefrom in a state of per-
fection ; hence the liver and brain do not add to It.

However, a careful enquiry into the truth shows that all such
views are untenable. The only possible view is that the breath
obtains the perfection of the given faculty in that member which
is the instrument of such faculty.

The continuation of the translation of Be viribus cordis is resumed at 1053.

Explanatory Extension of the Subject of " The Breath."

§ 136. Synonyms.—" The breath of life " (Gen. 2 7 • Quran
32-9) Souffle de vie; Ruach (Heb.) ; Ruh (Persian, Arabic)-
Hu (Sufi) ; Ch'i (Chinese ) ; Prana (Hindu)* ; Hauch (German) •
Spirit (as a translation of " spiritus," for which " breath " is the better
equivalent: see § 134, and § 129, footnote; spiritus is the Latin
translation of the Arabic nafs).

Primordial aura (Bruce, 11 p. 101) ; "ether" ; vivifying prin-
ciple ; vital fluid ; vital (cosmic) force.

Definition : that which binds the vegetative and sensitive life
into one connected whole. It is common to, and like in, all living
things. &

" Thatwhich centres in the cardio-pulmonarv centre. "(Baraduc. 110 )
" It is a subtle vapour which rises from the blood, diffuses itself
to the remotest arteries, and resembles the sun in luminositv fCh
M. 7 p. 8.) y ' K

Negative definition. — " Breath " is not " respiration," " breath-
ing," drawing in breath. Therefore it is not the equivalent of
anhelitus, nafas, anfas, Atem.

The expression " he breathed his last " actually describes
the departure of the " breath," but there are two events taking
place simultaneously, and the literal respiration is only one of
them.

It is not " soul " = anima. The latter is the Latin translation
of the Arabic ruh in various passages.

It is not " vitality," for this is the manifestation of breath.

* The Hindu system of physiology recognises five breaths as supporting the
body. They are : Prana (the air inhaled), Apana (has a downward course). Samana
(essential to digestion), Udana (has an upward course, or passes into the head)
Vyana (pervades the whole body and moves in various directions, transverse and
otherwise ; therefore, equivalent to the " breath " of the present section.) But
Prana mcludes the rest, ordinarily speaking.— E. A. C, Kaviratna, Charaka Samhita

126 THE CANON OF MEDICINE

Vitality stands for the vegetative soul. Thus, enfeebled vitality
means lessening of the ability of the vegetative soul to accomplish
some or all of its faculties.— Therefore it is not "life." (" Allah made
life to be in breath." Night 913, Burton, 10i v. 422).— It is not the
" vital air " of the 18th century chemists. It is not even vital
faculty " It is not amenable to either physical or chemical methods
of investigation. It is not a force at all, and therefore not analogous
to electricity, magnetism, heat, etc, though in the course of its
activity it manifests all such phenomena.

Breath is not " individuality."

Description by analogy. Being immaterial, and representing
a notion foreign to Western thought, breath is almost indefinable,
whereas to the Eastern mind there seems little difficulty in the con-
ception Analogies— such as to flame, a pendulum, a ladder or lift
to a higher plane of being, a chain linking the three aspects of the soul,
to lio-ht, to vibrations, and so on— are necessarily misleading.

& By picturing the breath as a sort of aura pervading the body,
with a polarity correspondent with the cosmic ether (its source, whence
it individualized into the human being), the conception of orientation
fin time and space) becomes feasible. Angle of incidence is then to
be considered, both in regard to every direction of space and to time
of day. Thus an infinite variety of constitution m these respects

becomes obvious. , . . • j •

R l37 —T/ie substance of the breath.— -This is mentioned in
several passages in the Canon. Though immaterial, the breath needs
a material basis or substrate. The substance is described as twofold :
(a) an aqueous vapour, in the case of healthy breath, as occurs when
the humours— the source of the substance of the breath (169)— are
healthy (b) A fuliginous vapour, like the mist of the early morning
landscape, if the breath be unhealthy— namely because, superfluities
are present in the humours. i

A more tangible idea of the substance of the breath is furnished
by taking it as partly consisting of oxygen, for the functions of oxygen
in the body are the same as those attributed to the breath which it
carries. Thus to quote L. S. Beale, " oxygen is necessary to dis-
integrate the soft formed material and combine with some of its
constituents."— That is, breath=mf, where m is oxygen.

In the Hindu system, there are ten substrates for the life-breaths.— Charaka, i.
402. — But these are anatomical.

The " primordial substance " of Chinese philosophy, the ground
of all phenomena, physical and psychical, fulfils the theory of the
breath. It is invisible and intangible, but manifests as matter (solid,
fluid gaseous), as psychic existence, and as spiritual existence. This
substance agrees with " breath " in showing cyclical changes, passing
from energy to inertia, from activitv to passivity, incorporeahty to
corporeality. The incorporeal is " the rule of existence implanted in
every living being" ; and " Li" is the Nature implanted by the
Decree. This principle of activity appears in modernist philosophy
as " mind." (Cf. Bruce, 11 p. 109.)

THE CANON OF MEDICINE 127

§ 138. The const-ant activity of the Breath. Were the breath
not in constant activity, the body would be " dead.' 5 - The activity
consists of (i) changes in quality, (ii) movement from place to place.
Actually, both occur simultaneously, but description would be im-
possible without taking each form separately.

(i) Changes in quality. This is a rhythmic waxing and waning
in intensity. ; a change from a strong phase to a weak one, and back
to a strong one ; a change from positive to negative ; an ebb and
flow; a condensation or concentration (" inspissation ■") and an
expansion or rarefaction (attenuation "). In the one phase there is
attraction of energy from without, symbolized by inhaling air ; in
the other, there is repelling of energy from within, symbolized by
exhaling air.

These phases of movement are represented by the terms jelal
jemal (Persian) ; jalal, jamal (Arabic) ; shiva, shakti (Urdul ;
Yin and Yang (Chinese); 23 masculine, feminine; active, passive;
etc. The rise is called Urooj in Persian terminology, and the fall',
Nasool ; it isa rise from no intensity (incipience) to great intensity ;
there is a period of maximum intensity (maturation) and a fall from
thence to no intensity (decay, defervescence, decline).

This cycle of the breath is continuous, but varies in rate — hourly
two-hourly, twice-daily, daily,* weekly, monthly, seasonal. Accord-
ing to its changes, so does the feeling of well-being of the person
change ; according to its changes, so are there differences of bodily
vigour in one and the same person. Every family, every race has its
type of " breath." Wherever we turn in living Nature we can see the
traces or signs of this " pulse of life "—in vegetable life, in animal
life, even the greater range of human history itself, the rise and fall
of nations, the rise and fall of pandemics ; the solar and planetary
cycles— all show the traces of this activity, though no doubt many
would consider the connection with " breath " very intangible in
these instances.

The explanation of this activity. This is to be found in the fact
of the cyclical changes in the imponderable elements, for the two
phenomena, as already suggested, are part and parcel of the same
phenomenon. Thus, breath, conceived as a vibration rate, is now
slow, now quick, now coarse, now fine. The range and changes of
vibration from " earth " (slow, coarse) to " ether " (quick, fine), and
back, as has been intimated, are associated with changes of activity
of the breath. These elements are, as it were, the points d'appui of
the breath, and they constitute an " immaterial " circulatory-system.

§ 139- — Relation of breath to temperament and the emotional
character.— So close is the relation between " breath," " imponder-
able _ elements " and "temperament" that description of the one
readily lends itself to being a description of one or both the others If
we trace changes in " earth," " water," etc., we are at the same time
tracing- changes in the activity of the " breath," and we use words
which apply to both " temperament " of the old sense, and emotional
character as spoken of to-day. Dominance of " water "is as much as
* Chloride-retention has a cycle of three or four days (Vallery-Radot "'p. 308).

128 THE CANON OF MEDICINE

to say " the breath remains in the ' water ' phase over a longer period
of time than in other phases— in this person." It also goes with
" jemal " type of character/the exact form of manifestation varying
according to other factors in the " make up "—e.g., quiet endurance,
silent submission to pain, ardour of aesthetic emotion, keen sense of
beauty, love of certain kinds of music, certain colours, flowers, etc.
(Note,- then, how intimate this idea of " constitution " becomes.)

The construction of a graph to represent possible variations may
be helpful, as long as its essentially schematic character is realized.

■*?

i*7K

sN"

■9-

•tf

•O

V-

The dotted area represents the
supposed temperament used in the
sense of 26, sqq. If it were ideal, it
-would be an exact square.

Note the necessity for four scales.
Reflection on this diagram, in the light
of the text, should bring out many
points which otherwise require lengthy
description. Strictly, no doubt, the
diagram would be improved if it could
be conceived in " solid form."

Diagram of a Person's Temperament.

To give another illustration — dominance of " fire." The
following are its modes : (i) the vibration-rate of the " breath "
remains longer in the " fiery" phase than in other phases and in
other persons*; or, weeks elapse before it reaches its climax (kemal
stage) ; (2) the temperament is " fiery," ; (3) the person is called " of
hasty disposition," " hot-tempered," he is " prone to anger " ; (4) the
climax of the fire-element may be reached suddenly : e.g., persons of
"explosive" temperament or disposition; the blood '" boils " ;
(S) the associated character is of jelal type, taking different forms
according to the manner in which the patient reacts to the circum-
stances of life: e.g. (a) possession of great physical strength,
(b) pugilistic power, (c) courageous in danger, (d) irascible char-
acter, (e) originality of thought, (f) ambition, _{g) a person with
unshakable gentleness, despite opposition (e.g., in some " saints "),
(h) proneness to enthusiastic beneficent arts, (i) zealous char-
acter, (7) cruelty of certain kinds (other cruel persons are called
" cold-blooded "), (k) strong desire. The whole range of human
activity can be drawn on for opposite examples.

. So also a slow rhythm of breath goes with tranquillity of mind,
and a liking for poetry and music. A moderate rhythm goes with an
active mind, keen to accomplish. A quick rhythm goes with energy,
forcefulness, and activity to a degree liable to lead to confusion of
mind and premature exhaustion of the body.

§ 140. Relation of quality of breath to will-power. The will-
power should dominate the breath. But it cannot do so consciously
if the individual is ignorant of the existence of " breath " ; persons of
vigorous will-power will dominate it unconsciously. It would be

* The ." ira " type, where " ira " is not simply the passion (anger), but a
definite jelal-type.

THE CANON OF MEDICINE 129

easy to see that dominance of will-power by the breath should be very
common, with the corollary that actions supposed to be initiated by
the personality are really quasi-automatic.

The will-power may be used to " develop the breath " ; that is,
the way the breath flows through the body, through the various
(nerve) centres.

§ 141.. (b) Relation to < " innate heat." The subject of innate
heat is very prominenfin the pages of the Qanun ; it is closely linked
with " vitality " (popular sense of the word) ( e.g., " enfeebled
vitality," " has very little vitality " ; " full of ' vim '"). The close
relation to " breath " is expressed by saying that as the breath wanes
(nasool phase), the innate heat lessens ; as the innate heat is restored
in the course pf nutritive processes, so the breath " waxes " (urooj
phase) ._ The rate of waxing and waning of the innate heat varies with
the individual and shows a relation with the similar phases of activity
of the breath. Innate heat is expended simultaneously with " breath,"
and at the same time comes that indefinable phenomenon — real
enough nevertheless— called " atmosphere," " personality," " radi-
ance," " aura."

This subject bears on the theory regarding the appearance of
pathological changes in the humours. Normally, the innate heat
is the agent which separates normal effete matters from healthy
humpurs. But in disease — that is, when the cycle of the breath is
not in harmony with the process of formation of the humours-
injurious effete matters (acrid, conosive, etc.) appear as by-products
of the abnormal humoral state ; the latter being the result either of a
change in the innate heat or of a conflict between this and " foreign
heat " (i.e. bacterial products : 485 : § 283).

§ 142. (c) Relation to metabolic changes spoken of (§ 83")
under the picturesque title " dance of the elements." The picture of
imponderable elements dipping down into the world of ponderable
elements (or, to be precise, the individual human being), and entering
into the changes of metabolism expressed as changes of pivot of
function from C to O, or H, or N, or S, or P in compound after
compound, and break-down into C0 2 or H 2 0, etc, or as formation of
tissue cells and their subsequent necrobiosis, etc. — all this is com-
pleted by the view of the breath, passing from phase to phase, from
strong to weak, not merely in one organ, but in every particle of the
whole being. With the ascending phase of the breath come the
formation of increasingly complex substances,— " generatio " ;
with the descending phase, goes the disintegration into simpler sub-
stances — "corruptio." Viewed as life-principle, we may think of the
breath as controlling the vegetative faculties of the soul, which are
associated by an intimate mutual relationship.

In this connection, the observation may be here noted that
change of electric potential arising from the metabolism of the salts
is necessary to the formation of active (as opposed to inert) fat in the
body.

Hence physiological action— that is, anatomy in motion — is not
merely a question of the behaviour of C, H, O, N, S, P, in the various

i 3 o THE CANON OF MEDICINE

side-chains, etc. It is a sum of potentialities possessed by the separate
imponderables and by their varying combinations, in the particular
individual at any given time. The common denominator or^ collec-
tive formula which represents this sum adequately is necessarily very
complex, and yet it is really essential that it be elucidated before one
could be said truly to grasp the real basis of a person's ill -health,
or intelligently work out the fundamental bases of prognosis.

5 143. (i'i) The activity of movement. — The second mode of
activity of the breath consists of a cyclical movement, a movement in
place, a movement comparable with a circulation. During the
course of this movement, the breath comes successively into relation
with the several tissues and organs, one after the other until it re-
appears at the starting-point.

The movement may be anti-clockwise as well as clockwise in the
various parts of the body.

But there are two paradoxes here. Firstly, there is no
period of time when the breath can be said to have passed a given
point. It is not like an object going round and round, like e.g., an
imaginarv drop of blood. The breath is all through the body all the
time. It' is more as if there were a series of lights m an electric
circuit, and they burning the whole time, but the intensity is changing
successively from point to point. The breath is always in the great
centres of the body (the " chakras, pranas "), but it is brightest in the
liver at one moment, and the brain at the next and so on— yet
following a certain order.* .

§ 144. Secondly, the circulation has no anatomical boundaries. f
Not only this, but it is flowing left-sidedly or right-sidedly. This is
transparently non-anatomical. Many would reject the possibility
and even an attempt at proof would be unsatisfying. The justifica-
tion for the statement that the breath is now left-sided, now right-
sided, flowing down each side separately, depends on subtle observa-
tions which are beyond the scope proposed for this work. It will
suffice to suggest just this : the peculiar attitudes adopted by all
creatures (animals as well as men) during sleep ; when standing or
sitting ; when exercising or at repose ; also the different moods
shown by a given individual — these and similar phenomena,
carefully watched, furnish adequate indications of the truth of the
statement. There is also a circulation along such intangible
" channels " as the temperaments of the organs.

§ 145. However, there is an actual relation to anatomical
organs as well. There is no ambiguity about this. The passage of
the breath from liver to brain, from heart to tissues is orderly, and
deliberately specified not only in the Qanun but in the De viribus
cordis, lest the unwary should be misled by the faulty ideas- of
Avicenna's predecessors and contemporaries. The heart as the
centre of life, and the seat of formation of the breath, is no mere

* This was realized also by the Chinese physicians as shown in the Classic on the
Pulse (vol. lxxx, p. 28) .

f Possibly this idea underlies the seemingly impossible Chinese statement : the
blood is inside the vessels, the * spirits ' outside."

THE CANON OF MEDICINE 131

fancy. To speak of the flow of the breath through the major organs
" awakening " each " centre " in turn (cerebral, thoracic, digestive,
genital) and then necessarily reaching the lesser organs (including the
tissues and cellular elements) is to give a true picture of life. To
insist also that in meeting the "centres" the breath is altered; that
it receives ; and then proceeds in that altered or renewed form to the
lesser tissues, is to fulfil the great law — the law of giving and receiv-
ing ; both together ; simultaneous ; balanced in degree. Both are
true. To omit one is to speak inaccurately because one represents
only in part.

§ 146. Application to physiological histology. — As has been sug-
gested, physiological histology is microscopic anatomy in motion.
It is the blackboard on which can be demonstrated the reality of
the truths of the scholastic conceptions. So, in studying the tissues
microscopically we must remember to introduce the conception of the
flow of the breath through the tissue-spaces, the juice-canals, which
are also the channels of the breath. Synchronous with this flow
there is an attenuation of cell-substance into fluids ; and a disinte-
gration of complex chemical substances into simpler ones. At the
same time, one must say " the change in the breath is attenuation
and aggregation of such substances."

Substances pass from the colloid to the fluid state ; from the
colloid to the crystalloid state ; from complex to simple ; and vice,
versa. They pass by _ aggregation from fluids into cell-substance
(" assimilation "). It is all one single process. That which we see
with the aid of the microscope is the "visible " manifestation of
cyclical changes in atom-groups, of carbon, hydrogen, oxygen,
nitrogen, sulphur, phosphorus, etc. The excrescence which we can
see on the nuclear contour of the leucocytes, for instance, is this
dominance of the several chemical elements — whether the change be
the outcome of " attenuation " or of " aggregation." Not onlv this
but the excrescence of the nucleus is also the effect of the change in
the breath which at different times belongs to different chemical
elements, and so to different morphological histological appear-
ances.

The conception of the blood-forming centres as the meeting-
point of two vitalities has already been suggested (§ 121).

§ 147. Application of the conception to pathology, (a) Disease
as the result of interference with the freedom of flow of breath, not
only round the body, but also away from the body altogether. — It
is clear that an actual obstruction in a tissue (whether it can be seen
with the naked eye, or felt with the hand, or whether it is in so minute
a channel that the microscope is needed to demonstrate it) prevents
the flow of tissue-fluids and is the forerunner of a morbid condition — a
" disease." But it exerts this effect primarily because the flow of the
breath is obstructed and its rhythm degraded. Could the two series of
events occur independently, the fact is that the former, the material
obstruction, would not suffice to set up such a morbid condition.

The following are useful concrete examples of diseases produced
in this way :

I3 2 THE CANON OF MEDICINE

The dire effects produced by hysterectomy in young persons,
once in much vogue for instance for severe dysmenorrhea ; and the
persistent ill-health which appears when it is done in older persons
round the prime of (child-bearing) life. The explanation is to be
found in the destruction of the "channels" of the breath— the
severance of non-medullated nerve-fibres, and even the actual removal
of important nerve-ganglia. This indefinable vital component of the
being which must '"' circulate," goes so far, and then finds a void, and
its activity is turned back on itself ; there is a revulsion ; and the
patient is aware of a great distress which nothing will (or can)

relieve. . . c

(ii) Jejunal ulcer following gastro-enterostomy, or excision ol

gastric ulcer. ' .

(b) Disease as a result of disturbance in the rhythm of the breath.
A change of rhythm, or an ataxy of the breath, would suffice to
initiate a loss of immunity to bacterial agents. Since there must also
be an outflow of breath, any associated interference with its current
would have the effect of holding back any of the isolated micro-
organisms which are always to be found in the tissues.*

In this way the organisms would have time to develop into active
colonies. Structural organic changes then appear in the body.

When Paracelsus said that " life-principle may decompose and
become a strong poison, furnishing life to innumerable, invisible
(i.e., microscopic) existences, by which infectious diseases are caused,
he was not speaking foolishly. 29 (p. 155)-

(d) The relation between the intracorporeal cycles of the breath
and the cycles in the outer world is a factor for consideration in regard
to the study of bacterial cycles in Nature, outside the bodies of animals
and other human beings. .

(e) Sudden recovery from incurable diseases should be intelligible
in view of the nature of the breath. Remembering the existence of
polarity, and a point of penetration into the corporeal being, and
considering the fact that in disease there is a distortion of the shape
of the breath, it is not difficult to conceive that some outer force or
power breaks through and restores the polarity to normal, in which
event the sick person would be once more in proper relation to bis
terrestrial conditions, and be freed from the interference (analogous
to the interference of light) which has previously occurred in the
activity of the breath. The event of such a revulsion occurring at
all whether the subsequent physical recovery be instant or only
reached by gradual stages, would bring the case within the category
of miraculous cure. .

S 148 —Changes of quality of activity of the breath are simul-
taneous with its movement from place to place within the body.—
The two aspects of the activity of the breath must be considered
simultaneously, for they are not actually separate. Thus, to sum up,

• This fact was again called attention to recently by Sir Charles Ballance.
(October, 1929; Lancet, 1929, 324-)

THE CANON OF MEDICINE 133

we picture the breath circulating from nutritive organs to those
of the sensitive life, awakening as it does so the lower passions
(the nutritive = " appetite " ; the reproductive == " desire " : see
•§ 160 ; and then the higher (the emotions, the " atmosphere,"
the " inspiration "). The faculties of each organ are " activated "
as the breath traverses them ; their vitality augments, and the
breath itself concurrently receives something from each " centre."
The " natural " breath is the phase, then, when the breath is con-
sidered in regard to the natural or vegetative processes of the body,
and is ''located " in the liver, and is associated with venous blood'.
The " vital " breath is the phase when it is located in the heart, and
is associated with arterial blood. The "animal" (or sensitive)
breath is associated with the nerve -fibres. Yet there are not three
breaths, but one breath — " not three souls but one soul." And the
" breath " is not the " soul."

The changing activities of breath are associated with changes in
the composition in regard to the cosmic elements ; with changes in
chemical composition. Movement of quality (type, rate, primary
quality) goes with movement in regard to place.

The expressions "a matter-of-fact person"; an "emotional
person " ; a " neurotic person," in the light of the considerations
presented at such length, are seen to be capable of interpretation in
terms of corresponding types of " breath," which are dominant in
the given individual (§ 138).

§ 149. All these changes have been analogized with a "dance."
The_ breath is the controller of both aspects of the dance. It is the
music of the dance which holds the dancers together. When the
music ceases the dance ceases, or degrades into a meaningless
disorder. _ And the ceasing of the dance is ' death' ; and the
degradation is the subsequent decomposition processes.

The player of the music, and the movements of the two dancers
should blend harmoniously to make the perfect dance. What if there
be inattention on the player's part ? What if he should not corres-
pond to the capacities and capabilities of the dancers ? What if the
giving and receiving between the music and the dancers should fail
at any moment ? Surely, then there is di'sease. Whatever modern
medicine has to say about etiology, this fact remains at the root of the
phenomena of all disease. In health, the dancers depend on the
player, and their dance is so perfect that they always respond to his
tune. But there comes the time when the (hidden !) Improvisor of
the music cries out " Halt ! "

I34 THE CANON OF MEDICINE

§ i 5 o.— The following repetition of some of the important facts so far discussed
is iustifiable for still greater precision.

j Abbreviations : a, animal ; 6, breath ; B, body as a whole ; C vital centres
(heart, liver, brain, gonad) ; /, faculty; h, heart; j, vegetative ; I life ; i,
life-principle ; w, mind ; «, natural ; r, rational ; s, sensitive or sentient, or sensuous ,
5, soul in the Platonic sense ; sp., spirit, v, vital.

(a) General Statements : —

7_ exhibits jf, sf, rf, and vf.
But L is not the same as ;/, sf, rf, and vf ; or the same as (;.s.) /.

L is not = jf+sf+rf+vf.

L is not the same as S.

S is not the same as L ; or m; or sp.

S includes L, b, jl, si, rl, vf.

b is not I, or L, though almost equivalent to I.

I implies b. „ . _ , , , . , . .

of (Avicenna) belongs within the domain of sf and rf (scholastic).

jl (scholastic) comprises vf and nf together (Avicenna)

si (scholastic) comprises vf, nf, and some af (Avicenna).

si (scholastic) is equivalent to nf. vf. {af—rf) (Avicenna).

rl (scholastic) comprises vf, nf, af (Avicenna).

rl (scholastic) includes jl and si (scholastic).

(b) Special Statements.

(i) The three chief views of the nature of a person are :
Modernist, or scientific or rational : ^ + "?- „ c , D

Popular or Platonic. f and B, or &+£.

Aristotelian. S.B., orSX-B.

(ii) The scholastic view may be thus expressed : „ . , x »»

" Nature " is L.B. ; the '* vegetable nature " is jl.B ; the animal nature
is jl.sl.B ; " human nature " is jl. si. rl. B. .

(iii) Comparing the description given by Avicenna, with that given by
S. Thomas, we have :

Avicenna (&.«/■ a D- B (Q

S. Thomas -f-B ; or (;/, 5/, rl) B

5. The Animal Faculties (Sensitive Life)

174. The animal faculties comprise those of (a) perception
(b) locomotion. The former comprises (i) external senses, (ii)
interior senses. Each of these exhibit five faculties.

" Now the ' Perceptive faculty ' (Mudrika) is subdivided into ten branches
five of which are called the External Senses,' and five the ' Internal Senses ' TW
former are Touch, Taste, Sight, Hearing, and Smell "— (Ch M ')

These faculties may be also designated faculties of the lower mind or lower"

+A ," + Au S ust f e says that the higher reason is that which is intent on the con-
templation and consultation of things eternal ... but he calls the lower reason
that which is intent on the disposal of temporal things. Now these twc^namely
eternal and temporal-are related to our knowledge in this way, that one of them
is the means of knowing the other." (. . p. r I2 ) .^The whole subject is to be found
treated in a masterly manner in this and adjoining sections of that work.

175„_ A division of external senses into eight is obtained
by regarding " touch '' as including four senses in itself, for this
is performed by more than one organ. Thus the tongue not only
tastes but has a sense of touch. This view follows the philosopher.

4 JtT S tT eS are ,£°* fu £ ther discus sed in the Canon. The following quotation
from Chahar Maqala (E. G. Browne's translation') may be therefore addld

Hearing is a sense located in the nerve which is distributed about the auditorv
meatus, so that it detects any sound, which is discharged against it by undulations
of the air compressed between two impinging bodies, that is to say, two bodies striking
against one another, by the impact of which the air is thrown into waves and becomef
the cause of sound, m that it imparts movement to the air which is stetionarT'n
the auditory meatus comes into contact with it, reaches this nerve, and gives rise
to the sensation of hearmg.-S^ is a faculty located in the opt c nerve which
discerns images projected on the crystalline humour, whether of figures orTolid
bodies, variously coloured through the medium of a translucent substance which
extends from it to the surfaces of reflecting bodies—Smell is a faculty locatelin a
protuberance situated m the fore part of the brain, and resembling tte nipjle
the female breast, which apprehends what the air inhaled brings to it of odours
mingled with the vapours wafted by air-currents, or impressed up^on it by diffusion

J r T^ ° + d0n ^ C J?° dy -r • K 1S really a ver y delicate ^nd of taste. The sense of
taste detects soluble nutriments in those objects which come in contact with the
tongue, discriminating between sweet, bitter, sharp, sour, etc. The sense ™ 'touch
is distributed throughout the skin and flesh of the animal, the nerves Serebv
perceiving and discerning anything which comes in contact with them— such as the
four primary qualities: dryness, moisture, heat and cold; and the secondary
qualities of roughness, smoothness, harshness, softness beconaary

^ * , sounds > the five tastes, the five colours, are simply manifestations nf
the five elements (cf Forks-, p . m , •• Your t&s ^ 3^^™ youi hea?Lg

etc.— these are the elements ; so say not they exist not ! " wearing,

176. The Interior Senses.. —

There are five groups of interior faculties : the composite
the imagination, the apprehensive or instinct, the retentive or

-35

136 THE CANON OF MEDICINE

memory, and the ratiocinative. The first two are taken together
by the physician, but not by the philosopher.

177. The 'Composite sense ( = Common sense: Hiss-i-mushtarik)
is that which receives all forms and images perceived by the ex-
ternal senses, and combines them (into one common mental
picture).

Site : Anterior Ventricle of Brain (Ch. M.)

The sensations of sight, smell, touch, afforded by an object
are conjoined, and the qualities perceived by the different senses
become gathered into one single percept. This faculty' exists in
virtue of the fact that all sensation and muscular action are two
aspects of one process. With the exercise of every sense-organ there
goes an exercise of muscular action, and the latter cannot occur
without at the same time arousing muscular sensations, because
sense-organs for muscular senses are everywhere present along the
fibres of which the muscles are composed.

178. Imagination. — (Phantasy.) This preserves the per-
cepts of the composite sense after they have been so_ conjoined,
and holds them after the sense-impressions have subsided. The
common sense is the recipient and the imagination is the pre-
server. The proof of this belongs to the philosopher.

The chief seat of the activities of these two faculties is the
anterior part of the brain.

§151. Regarded from the scholastic point of view, the imagina-
tion maybe distinguished into (a) sensuous, (b) rational, ox intellectual
The former is equivalent to Avicenna's term, for it concerns itself
with natural objects. The second form is concerned with ideas, is
creative or productive, and manifested as " invention " (artistic,
mechanical, scientific, etc), whereas sensuous imagination is simply
reproductive. But in both cases the faculty is defined as " the power
of forming mental images or representations (" phantasms ") of
material objects apart from the presence ofthelatter " (Maher, p. 163).

Source of the images : (a) the sensations, emotions and actions of the body ;
(b) trains of thought, which are chiefly on the higher plane of rational life ;. (e) the
intellect ; {d) other external influences, such as other minds, whether human or
angelic.

The difference from " common sense " is that the latter only
deals with objects while present.

179. The Cogitative Faculty. — The faculty which medicine
calls cogitative is taken in two senses in philosophy.. It is regarded
sometimes as "imaginative faculty'' [mutakhayyal : animal]
and sometimes as " cogitative faculty" [mutafakkira : human].

THE CANON OF MEDICINE 137

In the view of the philosopher, the. former is where the appre-
hensive faculty (q.v.) comes into play, and the latter is where
reason controls or decides that a given action is advantageous.
There is also the difference that the imagination deals with sense-
form percepts, whereas the cogitation uses the percepts which have
been stored in the imagination and then proceeds to combine
and analyse them, and construct quite different images : e.g.
a flying man, an emerald mountain. The imagination does
not present to you anything but what it has already received
through the sense-organs, (p.)

The seat of this faculty is in the mid-portion of the brain.

It combines or separates, as the mind selects, those particular percepts which
are stored in the imagination.

It is clearer to place the cogitative faculty into the higher " plane " of rational'
life. It really belongs partly to the intellectual imagination, and partly to the
rational faculty, the understanding.

180. The apprehensive faculty. — This faculty is the in-
strument of the power called instinct in animals. ^Animal
prudence."*) By it, for instance an animal knows that a wolf is an
enemy, and the kid distinguishes its dam as a friend from whom
he need not flee.* Such a decision is not formed by
the reasoning powers, but is another mode of apprehension.
Friendship and enmity are not perceived by the senses, nor do the
senses comprehend them ; and they are not perceived by the
reason either. Man employs the same faculty on very many
occasions exactly as does an irrational animal.

Apprehensive faculty v. imagination. — The former executes
a judgment ; the latter simply stores sense-perceptions.

Apprehensive faculty v. cogitative faculty.- — The former relates
to one single act ; the latter does not make a judgment, but
opens the way to a series of discursive processes and decisions.
The cogitative faculty is concerned with the synthesis and
analysis of sense-impressions whereas the apprehensive faculty
makes a judgment on the super-sensuous ideas in the particular
sense-percepts. The cogitative faculty is concerned with forms
perceived by the senses ; the apprehensive faculty deals with
derivatives therefrom (" suprasensuous forms.")
^ ] Some writers however call the apprehensive faculty " cogita-
tive " as a matter of convenience, saying that the terms are
unimportant as long as one understands the things themselves
and the primary differences between them.

*Or, as a child distinguishes between a spotted rope and a serpent, and dis-
covers the suprasensual ideas existing in particular percepts. (Ch. M.').

138 THE CANON OF MEDICINE

§ 1 52. Clearly, the apprehensive faculty of the text covers both
"lower reason" and "reason" as ordinarily understood. The
former is also called " instinct." The difference between the two is
easily defined in theory, but difficult to apply in practice. _ Instinct is
"the sense of what makes for the well-being of the individual."
" Concrete relations are perceived without an abstract conception
being formed. Instinct therefore differs from reason in the absence
of abstract universal knowledge. At either end of the scale, the
external manifestations are clear and absolute." 50

§153 Instinctive actions may be described as highly complex reflexes,
the movements being spread over a (variably) long time-period, and appearing
after a (variably) long interval. Thus we have :

(a) sensory stimulus— >lower nerve-centres — immediate reflex movement;
(6) the stimulus of a perception— >higher nerve-centres — >a series of com-
plex movements.
(a) need never reach consciousness ; (&) goes on without a consciousness of the general
(not " particular ") end or purpose of the movements.

While the subject of instinct is always discussed in regard to the actions of
animals it should be admitted that nine-tenths of our daily actions really belong
exactly 'to the same plane or order. The use of the expression " lower reason
enables a vast number of particular instances of animal behaviour to be classified
along with many similar actions performed by man, perhaps especially during

childhood. . . , . . , , .

Much of the difficulty about instinct versus reason m animals is avoided in
this way. It is also to be noted that while speech and language exist in various
orders of creatures, articulate speech occurs in man alone (Bock 114 ). Animals can
express their own emotions to one another, and can understand our speech m that it
conveys emotion. But that is different from the reasoning processes which scholastic
philosophy limits to man.

181. The apprehensive faculty need not be considered
much by the physician because disorders in it are always conse-
quent on disorders in the prior faculties of imagination, and
memory, as we shall show later on. It is only necessary to consider
those faculties the disturbances of whose functions bring on
disease. It is enough to know that the lesions in one which are
interfering with the other arise in the temperamental state of the
member or in depravity of its constitution. For on this know-
ledge depends the selection of the remedy and how to guard
against the disease. Not to know about tne state of a faculty
which is affected only indirectly is of less moment compared
with accurate knowledge about a faculty which is affected

directly.

182. The Retentive Faculty. Memory (Hafiza, Dhakira).
The power of memory is as it were a treasury or repository for
those supra-sensuous ideas discovered by the apprehensive
faculty, just as the imagination is the treasury or repository for
the sense-impressions of forms and sensible images (formed by
the common sense). The seat of this faculty is in the posterior
region of the brain.

THE CANON OF MEDICINE

l 29

The philosopher discusses whether apprehension and
memory are to be taken together or separately. Is apprehension
merely a treasury of reflection ? To the physician this problem
is irrelevant because the same noxa, be it an intemperament or a
depraved constitution, would affect both and in either case the
seat of disease would be in the same region of the brain.

The apprehensive faculty : memory : : common sense : imagination. But the
composite sense preserves forjns, and memory preserves ideas — the ideas discovered
by judgment (Wahm). (Ch.M. 7 ).

§ 154. In scholastic philosophy, the memory is two-fold —
sensuous and rational. Sensuous memory is the power of retaining,
reproducing- and recognizing the representations of past experiences,
and of referring an event to its place in time. The concrete obiects
of memory under this category are : memory of size, form, position,
weight, sounds, rhythm, scent, colour, faces, persons and of certain
events. The degree of capacity for memory in regard to each of these
varies widely, producing various " types," such as auditory, visual,
motor, etc.

The memory of emotional states is called " affective " memory.

Rational memory, the power of recollection, reminiscence, the
power of active recall, volitional memory. — This is restricted to man
(Maher, 50 p. 180).

183. There is still one more faculty distinguishable in the
mind, namely, the ratiocinative ; the understanding. Physicians
do not concern themselves with this any more than they do with
the cogitative faculty, and for the same reason. They only study
the operations of the four other faculties.

§ 155. Charts devised in order to co-ordinate various ter-
minologies applied to the sensitive and rational faculties.

u
bo

is
o

5. Ratiocinative Faculty

3 . Cogitative
Faculty

3 . Apprehension

4. Memory

2. Imagination

1. The Common Sense

I. Avicenna.

•a

5. Thinking

t-i

(=5

Tt-

2. Imagination

The Common Sense

II. Arabic (Nt. 449).

140

THE CANON OF MEDICINE

III. (Modern) Sufi"

Thouj

'0
tn

O
O

c/)

C/5

jht (of Goqj

Reasoning

Heart : .

sirr ; qalb ; ruh

Insight

Intelligence ( c aql)

Higher
Will ;
Attention
Hamm

Concentrating power

Volition

s- B .

cdW

r 1
: £.

1 — '

rt-

Judgment

" The Watcher "

Wahm

Reflection
Cogitative faculty
Fikr

1— i

0°

Conduct

Ideation

Asso

Sense-
memory

ciation of I<
Instinct

leas
Emotion

Per-
cep-
tion

Phan-
tasy :
Khayal

Imagin-
ation

Musaw-
wira

Memory
(of ideas)
Dhakira

Memory
Hafiza

Lower

Will

Nafs

Perception

Stereognosis

V Modern 139

Perception
Mndrika

(Psychiatric)

IV.

Jili 62 (]

p. r-v

THE CANON OF MEDICINE

141

Understanding
, Intellect
Power of thought

Supra-
sensuous.

Imagination

Sensuous

Reason

Instinct

Supra-
sensuous

Memory

Sensuous

The Common Sense

Perception

VI. Scholastic 60
Note. — These and innumerable other views regarding the faculties of the
" mind " are partly accounted for by difference of purpose in view. In ancient
medicine, everything was related to the cosmic elements ; in modern medicine
anatomy is all-important. In regard to mental diseases, cortical structure (strata
of types 'of nerve-cell) is naturally a basis of interpretation. Many modern text-
books of psychology consider principles of education of the young. Moral phil-
osophy has another object in view. Eastern mystics regarded the matter in terms
of the problem of attaining elevation of the soul to God. Standard modern Catholic
teaching envisages all such aspects, without making clear the links between " theoreti-
cal " faculties and the actual microscopic anatomy and histological physiology
of the human body. But these links are the essential interest in this treatise, and
are outlined in the special chart described and discussed in §§ 157 sqq.

6. The Power of Locomotion

184. This power is that which contracts and relaxes the
muscles whereby the members and joints are moved, extended
or flexed. This power reaches the limbs by way of the nerves and
there are as many forms of power as there are of movement.
Each muscle has its own peculiar purpose and it obeys the decree
of the composite sense.

§ 156. That the soul is endowed with a locomotive faculty is simply an
ultimate fact. Our life-long experience assures us that mind and body do interact
but how we cannot tell. (Maher 220).

The skeletal system is the instrument of animal life.

Movement occurs in plants, but so slowly that it was not positively discerned
till recent years, and is not a " locomotion " (see § 128).

7. The Functions (of the Body)

185. Some of the functions are carried out by one single
faculty ; others by two together. The former is exemplified
by digestion, the latter by the appetite for food, where there is
(1) the vegetative faculty of attraction, (2) the faculty of sensation
located at the mouth of the stomach. The faculty of attraction
is achieved by a contraction of the longitudinal fibres which
draw the object inwards and extracts from the humours that
which is required. The faculty of sensation enables the organ
to be aware of the acridity of the atrabilious humour, for this
it is which excites appetite. In saying that this one function

1 42 THE CANON OF MEDICINE

is achieved by two faculties together, one relies on the fact that
a nocument befalling the, faculty of sensation destroys that
" desire " which is called hunger and appetite. Even the need
of nutriment does not account for " desirei"

186. The function of swallowing is another instance of a
dual faculty' — that of attraction and that of propulsion. The
faculty of attraction is achieved by the longitudinal fibres at the
orifice of the stomach and oesophagus ; that of propulsion is
achieved by the voluntary muscles of swallowing. Loss of either
power renders deglutition very difficult ; even retarded activity,
without actual loss, renders the act. difficult. Every oneknows
that lack of appetite for a substance makes swallowing difficult.
If a thing is repugnant, and yet we wish to swallow it, our appetite
and power of attraction is so frightened away that the function of
voluntary deglutition is made difficult.

187. The function of transmission of nutriment along the
alimentary tract is achieved by the faculty of propulsion forwards
of the portion containing the nutriment. It is associated with the
faculty of attraction exerted by the succeeding portion.

188. The discharge of 'waste matters is also a two-fold
function. Sometimes both sensitive and vegetative faculties
initiate the function simultaneously.

189. In some cases a faculty is associated with a quality.
Thus cold holds material, and also arrests the flow of humour (or
intestinal contents^ either absolutely by repressing its formation
or relatively by driving it back. Cold restrains by (i) congealing,
the material (rendering its particles closely aggregated), or (2)
narrowing the pores. Incidentally it has a third action — (3)
that of obliterating innate heat (which is concerned with the
faculty of attraction).

190. Heat. Heat attracts by the ways already mentioned.
Heat and the urge occasioned by (relative) vacuum first attracts
the attenuated matter, and later the denser matter. The vegeta-
tive faculty of attraction only attracts the things most appropriate
for it, or things whose nature it is to be attracted. Consequently
it might happen that the denser (more concentrated) matter, being
more suitable and appropriate, and responsive, is attracted first.

Mouth . .

Stomach . .

Small Intestine

Liver

Choicest ingredients

completely become

BLOOD (SANGUINEOUS HUMOUR)

(Through S.V.C., liver, to heart and general blood-stream

(THIRD DIGESTION)

Watery residues

Bile (q.v.)

Normal Blood

Tissues

(FOURTH DIGESTION)

becomes

Living Substance

I
The Residues of 3rd and 4th
Digestion, "Wastes," "
go to: —

1. Kidney (Urine)

2. Skin: insensible perspira-

tion, hair, nails, sordes of
lips and skin

3. Tissues: obesity, fibrosis of

conn. tiss. ; neuritis (Beale,

P- 59)

4. Seminal fluid (both sexes)

5. Nasal mucus, earwax

Watery part

Urine

Abnormal

Because

admixed with

unhealthy

o
C

tr
c

3
o

3
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g

5"
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tr
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ttf

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sr
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p
cr

3
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3"
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Because of
internal change

Decom-
position (or
putre-
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some nor-
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stituents)

2
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8g.

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D-D.

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I
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5'
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com

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Tissues
Joints

5"?

Blood

Printed by The Westminster Press, W.g

VEGETATIVE LIFE Ouwu s

Large Intestine

BY-PRODUCTS

normal

Sediment, or
Precipitate of blood

WASTES

The non-utilisable surplus.

Non-assimilable.

Is exposed to undue heat.

Accumulates to over-flowing,

and then encounters the

expulsive faculty

TERRENE or ATRABILIOUS HUMOUR
(cold and dry)

Undergoes

internal change

(i.e. oxidation)

Normal derivate

1
Products

1
excrementitio us

1 .

.morbid

>-:

of
oxidation

atrabilious
humour

Goes to

of fluids
admixed with

i. Spleen ; thence to

-w*_-»

^— — ^

Attenuated Attenuated

cardiac sphincter

blood

>ur

portion of
Blood

bile

(81)
2. Blood:

(a) imparting vis-

V
The Ash

CO*

a to -

m unhe;
carried
It is "<

cidity

§1"

(b) to the bones,
giving them

■ a>

°> ft <"^

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stamina

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Oxidise
Serous

atrab
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("chc
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P n

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5 : i

>§

making it (a) sour,

d blood
humour ("
ilious hum
humour
)leric atrab
I atrabiliou

5 r*

p a

3'
a
Cu

l-t

o
c

(b) bitter

c?S

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our")

ilious
s hum

*■*■ g.

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ile"

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1°

ous
78)

re*

ING SOURCE AND FATE OF THE FOUR HUMOURS

Unhealthy digestion

ncomplete

Carried too far

(Decomposition)

Oxidative by-products

Non-nutritious Non-utilisable Residue

Excrement

Attenuated

Dense

See "Leek-green bile"

See "morbid atrabilious humour"

rmal (77)

Foamy part of blood

(subtile, and acrid power)

BILIOUS HUMOUR

(hot and dry)

Because of
Internal change

f-t-
5'
3

o
o

CTQ

re a

a 3

" rt

■*

o
3

o £*
o 2

<w »

t- rt-

P*5'

W
o

«§

o
c

3-
C

3
o
c

Normal Bile

Pure ; unadulterated ;

"Clear"

(Formed in Liver)

subserves nutrition

to
Blood

(gives it

"fibre";
diminishes
its surface

tension.
Therefore

red cells

less viscid

and traverse

capillaries

better)

to Small

Intestine

(cleanses its

mucosa of

viscid and

other
matters)

to
Lung

to
General
Tissues

Anal

Muscles

(Stimulates

defecation)

Q
o
o>

tri

CL.

o
c

Abnorma

Because
contaminated with

is also

a
Waste

serous humour

normal
atrabilious humour

attenuated

dense
V
i. Vitelline bile
(thick, like egg-
yolk) "Fiery"

oxidises to
;. Leek-green bile
(94) in stomach

oxidises to
7. Verdigris or
mildew-green
bile

V
becomes
Ash
("choleric atra-
bilious humour":
q.v.)

3. "Red bile"

("bitter serous

humour" : 78)

CHART SHOWINC

Mouth

Food and Drink
(FIRST DIGESTION)

Stomach .

Small Intestine

Utilisable part (True Pabulum)

Chyle, diluted with fluids
of the meal

Incorrrj

Liver

Through mesenteric veins,

portal vein, to

Liver

(The liver swells)

(SECOND DIGESTION)

via Sanguificatory Power

Sei

Watery residues

)UR)
blood-stream

Bile (q.v.)

Less choice ingredients

of the Food
SEROUS HUMOUR
(Cold and moist)

Abnormal

Normal

-I
Subserves
Nutrition

Abnormal ("i

Because

admixed with

unhealthy

Because of
internal change

o
C

3
o

tr
C

P*
C

3
o

o
c

3
o
c

Decom-
position (or

putre-
. scence of
some nor-
mal con-
stituents)

(TO

»i

2 CD

2.0-

S* o
o

° a

gOQ

Oxidation

P T3

<-+

(-f

D-

3 1

ft, hyl i~

o*
o

Tissues
Joints

p p
<? L,

co (JQ

r+ P

p p

C 3
o p.

Because
admixed with

o*
o
o-

tr
c

3
o
c

tr
C

Blood

O-

o
c

3
o
c

ordinary
(contains
salts : 75)

I
putresces

V
2. Scz/ty

serous
humour

(light)

H'
S;

o c
c <"

»"1 CO
-CD

O
C

Beca

internal

p
tr

CD
5'

P*
5'

v
n

The Correlation of the Various Faculties.

(Summary and extension of Thesis VI.)

§ 158. The correlation between the various faculties with the
mter-connections between the visible bodily organs is usefully
indicated by means of a suitable map or chart.

The following considerations are necessary in studying
the accompanying map. (1) There are no actual boundaries between
the faculties, even in the case of the discrete viscera. The internal
senses are " merely diverse aspects or phases of a single sensuous
faculty (Maher, 50 p. 96) as Aristotle perceived. To name
departments " of the mind, it must therefore be constantly remem-
bered, is simply to help the memory, and assist analysis of the various
mental operations. (2) Subdivision of faculties into " animal " and
human " is to be avoided. (3) The enumeration of mental faculties
given by phrenology is not vitiated by the fact that phrenolookal
charts are not anatomically correct. (4.) Since the strength ofone
faculty involves a corresponding weakness of some other, even the
very existence of the faculty may. be virtual.

§159. Brief. Description of the Chart.
Six discrete " planes " are represented, and are named according
to certain terms selected from those used in various classifications
1 he vertically placed plane serves to indicate a close relation between
this and each of the horizontal ones.

Plane I.— This refers to the vegetative life, and shows the various
organs and their mter-connections, as well as their relations to the
superposed planes. Connection with the lower extremity of the
vertical plane indicates the existence of " unconscious appetition "
in this sphere of life. This, the so-called "natural appetite," is
defined as the inclination towards a thing which is in concord with
its nature, without any knowledge of the reason why such a thing
is appetible "» (I, 656). It is inherent in the nature of " beine "
on this plane. fe

. Appetite is (a) natural (hunger, thirst, sleep, exercise, sex) lb) sensitive (reflex

nrt ret^U C) Cll°Z L T^ tW ° *%*" ^ ° n °^ ic coniitionTwhich are
not regulated by reason. The sensitxve appetite is under the control of the will
and can be strengthened or checked thereby. 1 ' (i. 656). Appetite in the sen Z of
sinful de S1 re, belongs to another aspect of the subject. A PP etlte < m the sense of

Plane II — This refers to the sensitive life. Sensitive life
comprises the power to know " (i.e., the faculties already discussed

143

i 44 THE C AN0N 0F MEDICINE

in 176-183 of the Canon, and shown in the charts in § 155), and -the
"power to love "(= " appetition " = "the power of loving that
which is the good for the individual" = appetitive faculty = desire).
The power to know is represented by Plane II and the power to love is
represented by the lower part of the vertical plane. ..Both find
their realization in organs depicted on Plane I.

"Lower" is used as equivalent to "animal" (as opposed to human) Scholastically
it is the antonvm of " higher." " Reason," again, is made equivalent to instinct
because popularly the latter word is taken to be the same thing as automatism.
In scholastic philosophy the phenomenon of instinct is appraised properly. Hence
"lower reason " comes to be applicable for a certain series of phenonena for that
which scholasticallv is called instinct is that which m modern life is called lower
reason " The word reason should however be applied strictly to those higher
operations which scholastics define with masterly precision.

Coincident with the mental representation of the thing— whether
it be good or evil for the individual— there is an agreeable or dis-
agreeable passive state of consciousness,, and this is called an
"emotion." Emotions are subdivided into " concupiscible and
" irascible " The former imply attraction or repulsion, and are :
love, hatred ; desire, abhorrence ; delight, sadness. The latter
concern the sense of self-preservation. They are : hope oi ac-
quiring an object which it is difficult or dangerous to obtain ;
despair of so doing ; fear of a threatening evil or danger, with
impulse to flee ; courage, when there is an impulse to remain ;

anger. . ,. .

The objects of each of these emotions are : concrete objects,
whether inanimate or living ; muscular activity ; experience
(excitement, adventure) ; emotion itself. For example, there may be
fear of hunger, cold, lack of necessaries of life (clothing, etc ) ; ot
illness; of death ; of punishment, of reproaches, of tears ; of loss of
prestige or reputation, of being misjudged or considered eccentric ;

fear of failure. . _,

Planes III and IV together refer to the rational lite, iney
appear separated in order to bring out the idea of active and passive
intellect They stand for: the " power to think." The vertical
plane belongs with these two planes as representing " the power to

W1 ' The power to think, or Understanding, is regarded as two-fold—
speculative and practical. The former, under the influence of the will
produces the act of contemplation, the object in question being purely
ideal (poetry, music, art, refinement, taste). It sees resemblances
sees the " simolicitv " of creation, and makes even the most thorough
difference seem quite secondary and insignificant. It includes
foresight, research, " wisdom." The practical understanding, under
the influence of the will, and by the use of the physical body, accom-
plishes constructive work.

"The power to will, or " rational appetite," precedes voluntary
movement. The inclusion of the terms " attention," ' conscious-
ness," " heart," " ego," on the vertical plane, is for convenience and
• does' not imply synonymity in every respect.

THE CANON OF MEDICINE

Plane V, as representing the " supernatural " life, is only
introduced for completeness, and its relation with the " lower "
planes, though intimate, is purposely not specified. Its necessity was
perceived by Jili (taken as a representative of Islamic mysticism, by
Nicholson 62 ) when he discusses the " perfect " or " ideal " man, and
some of its features appear in the chart representing his views (§155).
The subject belongs primarily to theology.

§ 160. — Details regarding the Emotions.

(1) It will be seen that there is no separate account of the
Emotions in the Qanun. They are only referred to incidentally,
except in the chapter on the Pulse (601) which describes the effect of
five particular emotional states on the Pulse.

(2) While classification of the emotions is unsatisfactory as
Mali- 5 " --■ ' ' ■" ' • " - ■ • J '

points out, the short list given by Avicenna is convenient
in practice, because every patient may be regarded as fundamentally
governed bygone or other, the others being relatively unimportant.

In this section such emotions as aesthetic and moral feeling are
not considered. The self-regarding emotions are referred to under
" Ego " (§ 164, IV).

(3)

Emotions and Their Correlations.

II.

III.

IV.

Latin name

Gaudium

Laetitia

Tristitia

Ira

Timor

Arabic name

Surtir

Lazzat

Gham

Ghadab

Faz 1

Chinese name

Hsi

Ai 1

Chii

Translation

Joy

Delight
Concupiscence*

Sorrow

Anger
Hatred*

Fear

Corresponding
Element :
Sufic
Chinese}

Aether
Fire

Air
Earth

Earth

Metal

Fire
Wood

Water
Water

Corresponding
phase of breathf

Jelal

Jemal

Jelal

Jemal

Dominant
Humour
corresponding

Sanguineous

Atra-
bilious

Bilious

Serous

(4) Relation between the emotions and the " elements." — There
is not a strict relation between individual emotions and individual
elements. As has been explained, all the elements occur together,
though one may be said to be more frequently dominant than another.

* The Chinese speak of seven chief emotions, concupiscence and hatred being
the two additional ones. Instead of "delight," "liveliness," and "love" are
equivalents of " ai 4 "

f In theosophical language this relation is expressed by saying that emotions
belong to the astral " plane. 29 (p. 167).

I Su-Wen (Forke 23 ; Wieger 141 ).

I4 6 THE CANON OF MEDICINE

The same applies to the phases of the " breath "-the degree of
vitality. Every emotion goes through three phases of activuy-
risfngf acme, falling,-as do the types of breath Hence different
words are required to describe each emotion according as it is weak,
strong, balanced, pure or mixed. (See §139, § 164, 11 ; ).

This complexitv is illustrated by the following mstance-the
relation- between "anger" and «>«.»--" Fire varies from dull
smouldering to a red-heat, and so to flame— flicker, lambient, gentle
pTle uriZ sudden flare continued light of different degrees of
fnteAsitt, fierce burning, ferociousfire. The phrases : one's blood bois,
he flared up,-and so on, are graphic enough. Actually the vessels
engorge, the muscular power is intercepted the mind becomes
confused ; the bile is set in motion, and may be expelled from the
gall-bladder, leading to relief (bodily as well as mentally), or enters
the blood more freely, engendering heat and increasing both the
acid and the bitter throughout the body. Whether a person is
irascible, or is difficult to rouse to anger, whether the passion will
smoulder (and hence show as a resentment, and spirit o ve •ngeance)
will depend on whether the humours are mixed or whether one or
other is definitely preponderant in the resting state

An angry person gives out a definite atmosphere a feeling of
beine "on edge." The effect on bystanders depends on their
dominant emotional state ; in some it provokes quarrelsomeness m
others perplexity owing to the discovery that the person is unapproach-
able Silence and appropriate interior exercises are indicated.
Angry words produce mental " sores " ; they may heal, or they may
be kept goingf or they may be re-opened, or become incurable.

An outburst of anger may be provoked by a clash of interests.
Thest vary widelv. Thus, two wills may clash ; the function of one
organ ma clash with that of another (e.g. menstrual irritability or
outbSrste of temper); clash of duty with self-wilL The intensity of
the outburst is according to the principle of jelal-jemai.

Anger may be manifested as a " liver-storm (variable dura-
tion^ "storms " from stagnation in connective-tissue spaces (longer
duStion) "^erve-storms " (short duration), " mind-storms (lead-
ing to criminal acts). These phenomena may come onu«.

CO Physical effects of emotional disturbance,- 1 he ettect 01.
anger on bodily functions has been referred to. Fear may ^manifest
as lastric trouble, indigestion, constipation. Panic-fear may provoke
dLSSa and polyuria. The blood becomes flooded with toxins,
and the kidneys are taxed in consequence.

The blood-state is altered during the sway of emotions (Cf. 1090.)
The blood-cell formula may also alter.

The humoral formula changes during emotional phases but there
is no rigid relation to be assigned. Those given in the table are not
absolute.

Analysis of a total emotional process. -Viewed as a complex process, the following
compote^St considered fn «^^^^^^^- : } £ ^

THE CANON OF MEDICINE 147

process along motor nerves (b), (iii.) bodily commotion caused by ii. -f b ; this
reaches consciousness through sensory nerves (c). Psychically, the emotion is
made up of i + ii. + iii. ; physically it comprises a + b + c. (After Maher, 5 °, p. 446) .

§ 161. — Details concerning some of the Faculties and
Phenomena pertaining to Rational Life.

The term "Mind" is variously defined. It is taken as synony-
mous with (a) intellect ; (b) intelligence ; (c) consciousness, conscious
intelligence ; (d) the nervous system ; (e) the brain (thus, behaviour-
ists employ " mind " for " brain " from a dislike of the materialistic
sound of that word 156 ) , (/) the entire psychical being. It is defined
as (i) a sum-total of the mental processes (Howell's Physiology) ;
(ii) that which thinks, feels and wills ; (iii) " the terminus of 'an
evolutionary progress from reflex and tropism by way of memory and
imagination to intellect and reason " ; (iv) " mind is to be interpreted
in biological terms, as an organism, an organ of adjustment,
a structural fabric " (Purposive school of psychology). 156 " Mind "
is analogized with a room, in which the soul lives ; with a
mirror which reflects every thought coming into it. The purpose of
this analogy is to illustrate differences between individuals just as
there are different kinds of rooms, styles of decoration, coloured
windows.

The scholastic definition of the mind is that it is the proximate
principle of understanding, and designates rational life as opposed
to sense-knowledge. Mind is not a special power over and above
the memory, intelligence, and will, but is a potential whole comprising
these three. It includes all those powers which in their operation are
entirely removed from matter and from material conditions. (St.
Thomas, Quaestiones Disputatae, De Veritate, x. 1 ; and ad 12 ;
Sum. Theol. 77, a. 5.)

Activity of mind. — This may be considered in three aspects :
mobile, rhythmic, and chaotic. The former is shown in gentleness,
generosity, gratitude, goodwill, easy-going disposition. Rhythmic
activity is shown in reason and logic ; in business-like character ;
moderation in love and hate, likes and dislikes. Chaotic activity is
shown in intolerance, suspicion, imprudence.

A. The Intellect. (Plane III, IV). — The active intellect is defined as the
power of abstracting, whereby the object obtained by the senses (the image stored
in the imagination) is disengaged from its individual conditions and rendered in-
telligible. It " abstracts from the representations of concrete things or qualities,
the typical ideal essential elements, leaving behind the material and particular ""
(I. 74), " manipulating them like algebra without immediate reference to the con-
crete." It considers things apart from quantity, quality, place, and time.

Relation of intellect to corporeal organs. — intellect is a function of the mind
alone ; it is not exerted by means of any organ (Maher 50 , p. 239, 240). Intellectual
activity depends extrinsically, or per accidens, on the organic faculties, as the school-
men said (ib. p. 241). Intellect is a spiritual faculty.

Whereas sensations of touch, or phantasms of colour are possible only to
a soul that informs a body, and can only be elicited by modification of an animated
system of nerves, intellectual judgments are not the results of a stimulus of a sense-
organ, but are products of purely spiritual action. " The inferior mode of mental
life is awakened by the irritation of sentient nerves, the superior activity is due to a
higher reaction from the unexhausted nature of the mind itself ; and the ground
for this reaction lies in the fact that the same indivisible soul is the root of both
orders of faculties." (ib. p. 242).

i 4 8 THE CANON OF MEDICINE

B. Perception. Imagination. — These are shown on both the II and the III
plane. (Cf. § 155)- "

C. Concepts v. Images. — The formation of concepts must be distinguished from
that of ' phantasms, or images. the concept is a representation of objects of a
class ; the image pictures only one particular colour, shape, size, etc. The concept
is fixed, immutable, and has no relation to time. The image is unstable, contingent,
and fluctuates. The concept represents the nature or essence in an abstract con-
dition, " ignoring or prescinding all accidental individualising conditions." " The
image' reproduces the object clothed with these concrete determinations." (lb. p.

237).

D. Thought. — This cannot be called a " sensation, "as shown by the question
raised by Balmez (quoted in Maher, p. 243) : " Is the perception of the difference
of the smell of the rose and that of the pink a sensation ? If we answer that it is
not, we infer that the judgment is not the sensation transformed, for it is not even a
sensation."

The mechanism of thought. — " The external objects stimulate the senses and
effect a modification of the sensuous faculties." The result is a sensuous percipient
act. " A sensuous phantasm arises in the imagination. The intellect now acts
and abstracts the essence, thereby generating the concept which expresses ( the
essence of the object. This abstract concept is then viewed by ' reflection ' as
capable of representing any member of the class. A formally universal idea is now
constituted " s0 (p. 311). " By comparison, reflection and generalization, the idea
is elaborated till we attain to the distinct and precise concepts or ideas which accurate
science demands" (Maher 17 : vii. 633).

E. Reasoning. — This is defined as a process in which a succession of cognitive
acts representing the various " notes " of a thing are unified, through relations
being established between them. It is the opposite process to intuition. By
intuition, one single act conveys all that can be known of a thing. The faculty
of reason seeks new and differential characteristics. The most minute differences
are essential. It includes : discerning power, sense of discrimination, classifying
power, sense of proportion ; observing power for (a) things, to see analogies and
resemblances between them ; (b) persons : e.g., character reading ; (c) ideas, which
link this faculty to that of the intellect. It also includes the attributes of order-
liness, method, sense of absurdity, and therefore merriment, humour, wit, sarcasm,
ridicule ; curiosity, mimicry, character-interpretation as by actors ; arguing, and
reasoning power pure and simple.

F. Intuition, or intuitive knowledge. — This term is variously used. In the
present volume it is intended to refer to a particular kind of knowledge obtained
through the use of the intellect, as applied to many of the topics of medicine.
That which is called esateric knowledge, or "wisdom," may be included under this
heading. Foresight, so-called mystical interpretation, insight are obtained by the
nse of the intellect influenced by mature experience. In medicine, as well as in daily

life, we may

" Look with spirit-eyes, and lo ! shall see
Glory in everv leaf o'erwaves the head."

(Night 94 ; Burton ii. 39).

" The spirit of faith is the habit of seeing everything in God, and God in
everything." F r - Plus.

From the Scholastic point of view, the following are proper propositions :

(1) All knowledge begins in the data furnished by sense-experience.

(2) Primarv principles are known by intuition.

(3) Abstraction and discursive reasoning are the instruments wherewith
we discern the nature of the data of sense-experience, their laws and causes. Through
these two servants of intuition the mind gains a scientific and philosophical knowledge
of things (Sum. Theol. i. 58, a. 3 ; II-IIa. 49, a. 5, ad 2m.). Through the same two
servants of intuition we arrive at the notion of immaterial beings and of God Him-
self" (i. 12) » (1, 84-88).

(4) " Concepts and reasoning, therefore, are in themselves inferior to intuition ;
but they are the normal" (i.e., usual, or most widespread) "processes of human
knowledge."

" For the Schoolmen, the intuitive act of intellectual knowledge is hy its
nature the most perfect act of knowledge, since it is an immediate apprehension
of and contact with reality in its concrete existence, and our supreme reward in the
supernatural' order will consist in the intuitive apprehension of God by our intelli-

THE CANON OF MEDICINE I49

fT^L l^ ^fic vision But in °« present conditions of earthly life our know-
ledge must of necessity* make use of concepts and reasoning " (Sauvage- vii , p 8 J.

§ 162. Occult Phenomena and Powers.— I. Common
usage applies the term " occult " to such phenomena as psychic
power healing power, thought-reading, telepathy, clairvoyance,
crystal-gazing, fortune-telling, discernment of the future, interpreta-
tion of dreams and visions, medium-ship, character-delineation
£•&• palmistry) divination, magic, sorcery, hypnotism, obsession,
willing another who is at a distance to perform some desired
personal service. Such phenomena are studied in theosophy
hermetic science, astrology (and medical astrology), spiritualism'
Christian science, and also figure in new-thought movements and
many other revivals and elaborations of ancient pagan pursuits «
(11. 19; xi. 199.) F

charlatISv ea t S he n fJ?*" Case * ther f, is the suspicion of trickery, deception, fraud,
charlatanry, the term occultism" is quite properly applied in an entirelv
different manner,-namely, to the investigation, by the useof reason and loSc

human SL (l - e The d f n % n0t / elf " e . Vident) CaUS6S ^ efects °P erative i* ordmf ry
human affairs. The events of one's own daily life, and those of one's fellows are
all natural sequences of previous behaviour: This is not realized and^vrong
conclusions are apt to be drawn-such as ascribing good or ill fortune to "fate "
or an extramundane agency, or to the deliberate ilLill of othen Better kno w
ledge of such a subject would enable one to avoid misjudging others T and to heTp
them better, by realising that every soul has his own way to |o and his own manne?
of proceeding on that way, toward the one final goal of all. manner

II. Occult phenomena in the common meaning of the term
are (a) true, (b) false. The latter are achieved by deception, or
illusion, charlatanry, or may be evidence of self-deception, or of
disease (hysteria, neurasthenia, mental disorder, insanity) The
former belong to two categories : (i) Impersonal; that is, explicable
according to physical laws, though at present only imperfectly
understood. Such phenomena manifest sometimes in inanimate
objects, sometimes m organized beings— animal or human (in virtue
of their possession of a receptive nervous system). (2) Personal.
(i; Natural; that is, manifested in human "nature" (a) actively
—in the case of phenomena of the kind referred to in 8 163 • (6)
passively— m which case the phenomena manifested in one person
originate m another or in numerous others (e.g. crowd-psychology)
° r u m J supernatural " beings, (ii) Supernatural agencies : (^so-
called disembodied spirits ; (b) angelic beings— good and beneficent,
or bad and malevolent, evil, satanic ; (c) the Supreme Being

Hi. The word " supernatural " has another application which
is properly and accurately explained only in Catholic philosophy (see
Cuthbert,"' p 28, sqq. ; Poulain,"*, chap vi ; Vassall-Phillips" •
etc). Ordinarily the human being lives a " natural " life, however
cultured unse fish altruistic, pious, virtuous. He may live a
supernatural life, by entering a " state of grace," so that the
human nature is transcended (super), as indicated by Plane V in the

very oi^niJZ^ ^^^y^^ ^ *** f ° r them at ^ ^ *ere was

i 5 o THE CANON OF MEDICINE

Chart. While living such a life, phenomena may become manifest
(e.g. visions, revelations) which must not be confused with those called

" occult." ! -

IV. Emotional states as a basis of occult phenomena. — Strong
emotional states may impress places and things sufficiently to affect
other persons in the absence of the original impressor. Obsessions
and haunted places are accounted for in this way. " A place or
thing such as a weapon or article of furniture, almost anything in fact
which has plaved a part in events that aroused very intense emotional
activity on the part of those who enacted them becomes itself satur-
ated as it were with the emotions involved. So much so that it can
influence people of exceptional sympathetic powers and enable them
to observe the original events more. or less perfectly as if they were
enacted before them. Thus in some cases the person will see the
occurrence as if taking place before his eyes." (Pater, 146 ; cf.

Benson. 157 )

V. Occult powers natural to human beings. — Some ot the
powers enumerated in the previous section are inherent in the human
organization. They remain latent, or they develop more or less
unwittingly as life advances, or they are developed by suitable
training. In a few persons they are naturally so decided as to
constitute a special talent, which may have been inherited.

. The possession of psychic powers (clairvoyance, telepathy, thought-reading
etc ) is sometimes looked on as evidence of special favour, or " spirituality,
or of superiority (being a " very advanced soul ") to be emulated. Such powers
are taken as evidence of sainthood in Islam « and among Buddhists 32 . In the
case of Christian saints, such phenomena are regarded as incidental, and not a
criterion of sanctity. Not only is there no relation between the presence or absence
of such powers and the virtue of the individual, they are attainable apart therefrom.

VI. The basis in the human constitution upon which such
powers depend is fivefold :

(i) The vital faculty (161 ; § 134) : vitality . . . . Vegetative Life.

(2) Instinct (180 ; § 153) Sensitive Life.

(3) The emotional make-up (159, 164 11 ) : . .

(The scholastic concupiscible and irascible phenomena) Sensitive .Lite.

(4) The imagination Sensitive Life.

(5) The reasoning powers ; deductive logic . . • • Rational Lite.

§ 163. The following powers are specially pertinent to medicine:
(i) Ability to read character. — Fundamentally, this_ is the
instinctive discernment of friend from foe. It exists from infancy,
and is to be observed among domestic animals. With the develop-
ment of reason, the consciousness becomes more and more aware of
the attractions and repulsions produced by another individual,
whether actually present or only thought of. As life proceeds.the
contact with relations, friends, acquaintances, and strangers, leads
to better knowledge of character, though perhaps nothing more than
a form of " worldly wisdom." The reasoning power may be deliber-
ately brought to bear, since delineation of character is amenable to
rule, and can be studied, and taught to others*

* The Chinese sought to establish a relation between character and physique
as long ago as 450 u.c. (Wieger, 144).

THE CANON OF MEDICINE j SI

As mbusiness, so in medicine, it is a subject worthy of attention.
Indeed it is always imprudent to neglect it.

(ii) Telepathy. Thought-reading.— -These depend on the first
three of the above-named powers, and not on reason. They cannot
be learned from books, and the experience cannot be taught to
others. _ The most striking examples of genuine powers of this kind
are furnished between (a) parent and offspring, when there is intense
mother love ; (b) persons between whom there is special friendship ;
(V) husband and wife, when there have been years of unbroken
mutual understanding.

Since they are powers inherent in human nature, they may be
developed gradually by concentration and will-power, exerted— not
over others, but over oneself. (Cf. P'u. Sung-Ling. 153 )

(in) Healing power. — (a) Involuntary. Success or failure in the
handling of many cases in ordinary practice is usually ascribed to
the concrete methods employed or the appliances used. Yet it is
often thought that the personality of the doctor (whether he be
specialist or not) has at any rate something to do with the efficacy of
the treatment.

• a The followin g factors contribute : inspiring confidence, the bodily state being
influenced through the emotions ; possession of great vitality, which favourably
influences a debilitated state through the vegetative powers, even apart from actual
personal contact ; will-power even if used unconsciously has a bracing effect on the
pat-ient ; psychic power, even when the owner is unaware of it, may directly influence
1 j OC u me and hormonic ( e -&-) activities beneficially, and the vegetative life in general
A disharmonious person will actually drain vitality from a weakly person.
The mother's touch takes away the bodily pain of her little boy.

(b) Voluntary.— Among the laity there is sometimes a deliberate
attempt made to develop so-called specific psychic healing powers,
through healing circles, and the like (theosophy, Christian science^
etc.).

_ The fact that such practice is at the expense of exact anatomical and physio-
logical knowledge and is exalted above medical training, cannot but arouse condem-
nation. Medicine herself is not a little responsible for the rising up of " healers "
m her lack of appreciation of the insistent reality to many patients of the sufferings
which she cannot explain or find a physical basis for. On the other hand, if the
psychics " possessed genuine powers, they would not lose them by going through
the proper doors of the medical curriculum, and their patients would be the gainers.

_ Of this it might be said that Medicine would not suffer by candidly acknow-
ledging its occurrence through her leading voices. Not to do so exposes her to
disrepute m the minds of those who have experienced the cures, or have personally
met with such cases. Though ignorance in various forms (prejudice, intolerance
party spirit) is inevitably in her ranks, it should not be chargeable to Medicine
herself.

.„ " The sectarian thinks that he has the sea ladled into his private pond "
(lagore, Fireflies, 209). e

§ 164. Lists of Terms applicable to Mental Faculties

and Affections
Individuals may be described in terms of a series of " notes "—
the physique, the emotional make-up, the temperament, or disposition,

i 5 2 THE CANON OF MEDICINE

the character, and the talents or intellectual capacities. These
together make up the " individuality."

The following lists under each " note " do not attempt complete-
ness, and some of the descriptive words might be placed equally under
other headings than those given.

I. Physique.— (i) General.— Robust, spare, wiry; strong or delicate

("constitution"); good or deficient amwH-'<?»» cla^si-

(ii) Special.— Classified according to the nine systems of Dr. Abbott s classi
fication or according to such types as these (Stanton* -)-vege tative thoracic
glandular muscular, osseous, nervous, etc. Basis: features of the face siz-
and shape S head, hands, fingers, feet, etc. Throughout, it is necessary also to
speci y the qualities' of strength and weakness in their degrees (i. si ight or minimal
2 moderate ; 3, normal, average, mean, or " equable ; 4, well-marked , 5, *ery

"^T^MOxToNT^MAKB-UP.-Classification according to the five headings
of the table in § 160. Basis: the character and phase of the breath ; the degree
of vitality • the dominant imponderable element ; the dominant humour To
draw up a formula to represent the emotional make-up conveniently for clinical
wotI the initial letters of the (Latin) names of the emotions may be used,the dominant
Amotion being expressed by a capital letter. Degrees of intensity are indicated
bv index Lurls drawn up as in the preceding paragraph. For example, a Timor -
pison mfght be represented by ^formula g* 1- tr* i> T* ; an Ira "-person might

be ^^^^l^cRiMiiK of the Several EMoxioNS.-These are arranged
alphabetically, and not according to order of severity. In some cases the words
apply also to mental states or attributes sometimes associated with the given

emOti 7 ^: ty blissful, buoyant, ecstatic, enraptured, enthusiastic, entranced, exalted,

^^iS^affectionate, amorose, cheerful, contented, eager, excited gay
inquisitive lively, love of (a) objects (collecting spirit), (6) wealth m various forms ,
(°) q opposrte sex ; pleasure ; sentimentality ; sympathetic. (Some of these convey

MeaS != te< achJng S^ffictiL, anguish, anxiety, bitterness, ^en^arted,
chagrin cheerless, dejected, depressed, despondent, discontented displeased,
^quieted, distressed, fretting, gloom, grief infelicitous, ^^■ 1 ^^S.

S^^r^^nT^seSei ^olSd^^^S^ ^d^

tribUl t^ ^^o^^^^^^s, bellicose, ^ter, boiling bold,
bristling cantankerous, capricious, captious, caustic, choleric, churlish, contentious,
contary cross, cynical, daring, desperate, displeased easily ofi ended, ^asperfed,
exceptions excitable, fierce, fiery, fractious, fuming, furious, hasty, having hatred,
topeCus indignant, infuriate, irate, irritable, irritated, jealous, passionate .peevish,
petted, petulant, pugnacious, quarrelsome, querulous rabid ragi ng ^lentless,
resentful, severe, shrewish, sore, storming, sulky, sullen, suspicious, tart, testy,
vengeful, vexed, vindictive, violent, virulent wrathful. _ o . , , , hrow .

Fear : afraid, aghast, alarmed, anxious, apprehensive, astounded brow-
beaten, cowardly, cowed, coy, craven, daunted, despairing, despondent, £ffident,
discouraged, dismayed, disquieted, dreading, envious, *f*-^^\^XI'
fearful fidgetv flinching, flurried, frightened, fussy, gentle, harassed, hesitating,
hoSedrhlr/or-struck, Irresolute, irritable, jealous, mistrusting, . ^^ous panic-
stricken penitent, perturbed, pious, pusillanimous, quailing, quaking quavering,
fepentant P restless, Scared, scrupulous^ shrinking shuddering, sh y : ;kulking sty
solicitous, startled, suspicious, temperate, terrified, terror-struck, timid, timorous,
trembling, trepidation, unmannered, weak-hearted, whining, worrying.

Moods. Moodiness. Disposition. " Moods are the waves rising in your
heart " They are due to the changes in the breath from hour to hour or day tc .day
The rate of change varies in different persons. When the change ^comparatively
frequent, the person may be described as moody, -changeable. Tms character
may occur more at some periods of life than others in the same perso n ; Thus
it is more frequent at puberty and during youth. It is possible to rise above the
cycle of moods, by the exercise of self-restraint. Moods change with surroundings
(places and people).

THE CANON OF MEDICINE i 53

III. Temperamental type, or disposition.— Basis : the humoral formula
This is expressed outwardly m differences of (a) texture-varying solidity of the
tissues of the body ; (b) development of the various parts of the body • (c) rate
of activity of (i) vegetative processes-nutrition, waste, formation of' germinal
cells, etc (u) expenditure of nervous energy ; (d) tonicity of muscles and nerves
The words descriptive of temperament often apply also to II. Examples ■ aggres-
sive, amiable, austere, buoyant, capricious, cheerful, chilling, churlish; complfcent
conservative courageous, depressed, despondent, discontented, energetic enthusi-
astic, excitable, fastidious, forbearing, fretful, forward, gushing, harassed impetu-
ous indolent, intolerant irascible, irritable, jealous, malicious, moody, obstinate
petulant, querulous, rebellious, reckless, remorseful, ruffled, secretive spiteful
stubborn, submissive, suspicious, taciturn, tranquil, tyrannical, uncompromising
unforgiving, verbose, vindictive, zealous. P mg '

Many of these terms also apply to the description of II and IV
It is worth noting that among these types there are many' which are sun-
posed to be evidence of high human aspirations, and yet strictly belong to the
• l^er mind. Hence it has been very truly said : " Those sweet affections which
incline the heart to God . . . come from the sensitive temperament, or bodily dis
position rather than from the solid piety of reason, and are carnal rather than
STL (Las^ "•)•-" Things that are apparently of the highest order in know-
ledge and art and sentiment are not things of the spirit, but things of the sensel

^ai^orthft^^cSr Aqumas and in the modern rfsearches inTe>

IV Character.— This is really a collective term, since all the other " notes "

contribute to it The terms which describe character may be groujed under

sensuous, intellectual, moral, and aesthetic groups, or under the five subdivisions

""£ f Ufi * ermmol °gy ( E go, Memory, Mind, Heart, Conscience) Many

rou afone m ° re ^ com P OIlent ' and therefore do not belong strictly to one

Ego : Positive: acquisitive, amative, approbative, artful, artless avaricious
arrogant boastfu. churlish, domineering, gluttonous, grasping, grouching inquteTtivI'
jealous, lewd licentious, loud, obdurate, obstinate, puinlcious, S quXlsome'
sociable, superstitious vain, voluptuous, worldly. Negative : abstem ous apathetic'
hasty indolent, indulgent, miserly, shy, timid, unselfish, weak pathetic,

pm . ft ,"?. ; Positive : accessible, adaptable, affable, altruistic, ardent, benevolent
contemplative, emotional, charming, compassionate, facetious, fascinating frivolous
gay, harmonious, hospitable, lively, peaceable, philanthropic, sincere Ste
tranquil.— Negative : tepid, meek, lenient. ^ ' ' falm P ie .

,.„„« Con J dence •' Positive J ascetic, austere, blameless, brave, conscientious
conservative, courageous, diligent, exacting, fastidious, humble, industrious perl
severing, scrupulous, sensitive, strong-willed, thorough, truthful well-balanced
Negative: deceitful, defiant, flippant, impetuous, impulsive, imprudent mafc tons'
pusillanimous, resentful, slow, treacherous, unforgiving, ungrateful unsociaMe'
untruthful, vindictive. (The moral sense may be absent) unsociable,

Mind Agnostic ambitious, brusque, censorious, cunning, enterprising
foreseeing, intellectual, loquacious, methodical, opinionated, orderly piauslblf'

?nner 1 t; C A ; o Pre]UdlCed ' ^^ "^^ S&titiC&1 - S ^P tiC ' seri °^, StUtef SuM e'
superstitious, uncompromising. ' auuulc '

It should be noted that character is ^) native and unalterable
(whatever some educationists say) ; (b) capable of being fashioned by
the will of the person himself or by that of the persons amongst
whom he lives. To have a " strong character " is considered the
highest ideal by many ; (b) is therefore much advocated. But this
idea is not necessarily true. Animals have character in that different
kinds of ego are as it were personified in them. (cf. Paracelsus^, p. 209)

Character is necessarily intimately related to physique
emotional type and temperamental type. Hence character de-
lineation is possible from a close study of those aspects.

The skeletal system (bones, joints, ligaments, muscles, etc.) is '
the expression of the character of the cerebral nervous system.
ine viscera are the expression of the character of the vegetative

I54 THE CANON OF MEDICINE

system. Hence it happens that the usual autopsy discusses the

least important part of the " case." (See §127.)

Interests Ex. : personal interests : the preservation of one's life and
health and general welfLe ; interests of the family ; of the social circle, etc.
Tr,+prp=d-c; manifested in the usa of the various talents. , . , ,j_

htU V t™ -These are best classified according to the subject-matter
to which the mind is directed ; though they may be classified according to the

faCU %LTaS d ' constructiveness; architecture, etc. ; technology

Scientific : all branches of learning ; mathematics, sciences, logic, analytical

tilents ■ calculating powers. Domestic science. Administration.

^ intelUauat: til branches of knowledge Philosophy,, history, sciences

JEsthetic: arts and crafts, music, sculpture designing, painting, poetry,

literary art, dramatic art ; wit ; women's crafts of all kinds ; poise.
Imaginative : originality ; inventiveness.

Moral : perseverance, concentratmg-power, law. no A~„ n <nr ■

Other talents: language; intuitive perception; foresight; pedagogy,

rhetoric; vocal. , , „ A

Social : domestic interests ; love of children of home. ,

Political. Military. Sport (athletics, acrobatic art, adventuresomeness) .

Commercial life. Agriculture, Husbandry. Ttmieht

Much overlapping is necessarily present m preparing such a list It mignt

be extended to mcPudf all the subjects taught in universities, and schools of all

kinds, for persons of all ages.

S 165 Interactions between the various aspects of the Soul.

I. Intellect.— Acts on vegetative life via emotions. (Effect of emotions on
bodily functions : § § 139,160)

IS (tffegtauZlife : physical desires, sense-impressions, especially in dream

(M s£iHv,% ^psShical desires, either in oneself or from others. The

imagination influences it in hypnosis.
(c) The will :■ compelling attention or forcibly diverting attention.
8 Other wills : ditto, includes angelic ^intelligences as well as : ^man

II. Reason.— Acts on vegetative life vi& the emotions, with their desires

aQd fe is r acted on by sensitive life. Emotions strongly affect the reason in people
of certain ^Positions life _effecting exterior actions.

Acts on fens^ve life. Through sensuous cognition it acts °n the emotions
feeds or starves or fails to starve the sensitive appetite, and so acts m the same

^J^Z^^^^^^^^^ aid of bodily mechanism it

l6adS A^n^S^ r^^^P-duc-es acts of Judgment, or worship,

or contemplation. . ,,

Acts on the intellect : " concentration.

Acts on the memory : " recollection," watchfulness. ron rKved

Acts on itself : brings perseverance in the performance of a design conceived

and elaborated by the intellect.

^'™ l&^aTSnen this propounds to the will what is the greatest good ;

^Trr^ir^fol in nullifying will to good, and ^sing
will to evil So also, fear of another person, fear of an idea, fear of a thing ^ssions
hinder the judgment, and so affect the will. Emotions can be sublimated by mter-

^W vfTpMile : this acts directly on the will. If the objects * .both
appetite and will coincide, the will is strengthened , otherwise it is ^^
"The passions modify the organic conditions and this influences al ? ^gmtive
faculties, and their intensity may prevent the mind from applymg itself to the
higher operations of the intellect and will (" 9, 10, 77 I *•. P- 6 5<>)-

Vegetative life : the corporeal state affects the will „„.,..,.„

Environment : circumstances of life, personal atmosphere of neighbours,

THE CANON OF MEDICINE i 55

etc. ; presence of persons of strong will, all interfere with or modify the actions of
the (patient s) will. J

Diseases of the Will.— Inconstancy, irresolution (lack of energy), impulsiveness
(excess of energy ; excitability), and " mortal sin " (domain of moral philosophy).

IV. Practical Application.— The fact that feelings, im-
aginations and thoughts influence the character is of the greatest
practical importance, but by using the will-power to control them all,
one becomes also master of one's life and " fate." Each emotional
" note " has its own effect on body and mind, and can be over-
ruled by the will. The influence of the imaginations is implied in
the phrases ' ' looking on the bright (or dark) side of things . ' ' Cheer-
ful, gloomy, constructive, destructive, upright, deceitful thoughts all
affect the sum-total of the conduct, the attitude of the mind towards
others, and can all be over-ruled by the will.

" If the endowment is great in one direction, it is at the expense
of some corresponding defect in another direction, as when tender-
hearted men are lacking in judicial faculty, while men in whom the
judicial faculty is prominent tend to be tyrannical" (Chu Hsi, 1 " p. 59).
The study of all such interactions as are suggested by the lists
of synonyms above given affords a better idea of what constitutes
ideal " balance " in regard to the various components of the human
being. A more graphic and tangible idea is at the same time
obtainable in this way of much of the subject-matter of ethical and
moral philosophy. To assign a distinct place for it in the domain of
Medicine is not to disown the precedence of religion.

THESIS I. DISORDERS OF HEALTH

i. Definition of the Terms *. Cause, Disease, Symptom

191. Cause. — The word
" Cause/' in medical works,
refers to that which initiates a
given state of the human body,
or maintains a fixity of such a
state.

§ 1 66. It is to be noted, says Costasus, that the term cause does not refer to
" efficient " cause, for disease, not being a definite entity, does not require an efficient
cause. In other words, disease is not in-formed matter. — This applies equally
in modern thought. If the changes of disease are modified biochemical reactions,
they cannot be considered in terms of matter and form. But formal causes, and
substantial causes, as well as the differences between qualities and dispositions,
tendencies, passive and active states, and fixed morbid conditions, are all better
understood under the precise thought of modern scholastic philosophy. — A cause
may be understood as anything which effects, or assists, or maintains, or imparts a
(morbid) function, whether actively or passively — morbid, because this part of
the Canon is concerned with disease.

Human body. Not an animal body. The teaching to be presented does not
necessarily apply to veterinary medicine.

Fixity of state. — Note that some states are labile, and others are stable or fixed.
Labile states are more or less easily curable, but fixed states are very difficult to
resolve or cure.

State. — We must distinguish carefully between cause, disposition, state, habit,
symptoms.

192. Disease. — This is an abnormal unnatural state of the
human body, in virtue of which injurious effects result. This
injurious effect is the beginning of the disease. Such an ab-
normal state is either (a) an intemperament, or (b) an abnormal
composition (see 205 5 231.).

§ 167. It may be noted that on this view the state is primary,
and the disease secondary. To the modern view, the disease comes
first, and the state is its result. The state is " the reaction to the
causal noxious agent." Such a state is (i) detrimental to the body,
(a) by an " aggressive " action upon the tissues by the agent, (b)

156

THE CANON OF MEDICINE 157

as an unfortunate by-effect, producing degenerations of various
kinds and degrees — sometimes mechanically (pressure on parts,
interference with vascular supply) — sometimes incidentally, in the
form of late toxic actions of the microbic poisons, (ii) beneficial to
the body — though indirectly, since it is certainly damaged in the
process — as tending to destroy the invading organisms or at least
neutralizing the poisonous products.

In Avicenna's view, however, both agent and state are equally
important. One cannot speak of a " reaction," any more than one
would say (for instance) that sodium carbonate is a reaction to
hydrochloric acid. Unless both substances are there, there is no
reaction. So, without an abnormal state, there is no malady.

Note also that " poisoning " (" intoxication ") is not a disease.

§ 168. The following classification of words often used indifferently for
" disease,' as if they were really synonymous, will help to a more precise usage.
A - — Terms bearing primarily a general sense.

Ill-health : not used specifically ; there may or may not be a diagnosable
" disease."

Illness : the state of being ill ; sickness. Vaguely used for anything
from slight disability to a fatal condition. More definite in meaning
than " ill-health." &

Malady : (lit. ill condition ; male habitus). A synonym for " an illness,"
appearing in polite literature for conditions not necessarily organic
or for conditions which have not been diagnosed, and yet may prove

IcLlcLJ..

Ailment. This may be some definite morbid condition, or simply implv
discomfort (possibly short of actual pain). Literally, is synonymous
with " a sickness," " an illness."

Disorders, in general, (cf. 198.) This term is used still more specifi-
cally, as a rule. See under B.

Disease (Morbus. Marad) in general. This word is technical, whereas the
other words have a more popular application.

B - — Terms bearing a special sense, whether used in that manner or not.
(i.) Any condition in which an organic lesion — some macro-
scopic change in the body — is present, is - " disease "
This word implies a more or less serious disturbance, and
even suggests the risk of death. The lesions present
often determine the distinctive name of each separate
disease. Where the etiology is still unknown, the

disease may be provisionally named ... "sickness"

(ii.) Conditions in which there is not necessarily any organic
lesion, or where such a lesion has not been detected.
These conditions do not receive distinctive names ; are
not necessarily serious ; are probably not fatal. The
name of each condition originally bore a distinct
meaning :

(a) arising out of the temperament - " distemper "*

(b) arising out of the disposition or state. Now

means simply " not fit " ; or, vaguely, " ill-

health." ----... "indisposition."

sub-classified according to the "system" in-
volved. . Or, vaguely, means simply " some-
thing is out of order." ---.. "disorder"
(a) implies involvement of the nerves, or nervous
system. (I.e., almost equivalent to " functional "
as opposed to " organic " (Lat. passio). Implies
a certain amount of pain - - - " ,iff fi -tioK "

* Now only applied to a specific disease in veterinary surgery.

i5«

THE CANON OF MEDICINE

(e) A condition in which pain is the chief, feature,
whether general, or in some special region ; but
the pain is presumably not very severe. Sub-
classification according to the region or organ

" complaint."

193. Symptom. This is a phenomenon consequent upon
this non-natural state of the body. Some symptoms are entirely
abnormal phenomena, like the pain of colic. Others are (ex-
aggerations) of a natural phenomenon, like the intense flush on
the cheeks seen in peri-pneumonia.

§ 169 A lengthy discussion about what is to be regarded as a symptom is
here given by Costasus. He shows that the word " symptom " is derived from the
Greek to indicate something which occurs simultaneously with the disease producing
it He also discusses the exact meanings of the terms : weakness, impaired func-
tion loss of function, abolition of function, " affections," preternatural excretions
and retentions (cf. " retained " placenta). The question is also raised as to whether
a given symptom is directly due to the disease, or is indirect, or is collateral, or is m
no real relation to the disease.

Avicenna's brief statement really covers all these points. As regards our
modern ways of thinking, one gathers together all the phenomena which are ever
found to occur in a case of a given disease, and we simply arrange them as far as
possible into the immediate effects, the remote effects, and those phenomena whose
nature is not absolutely certain— thev may be caused by the disease ; they may be
sequels ; or they may be concurrent because some other morbid condition is, or
happens to be, simultaneously present.

194. A short table of examples.

Example of a cause.

Decay ; putrescence.

Fulness of lacrymal sacs from

developmental error.
Acrid " flux."

Example of its
corresponding malady.

Fever.

Obstruction of uvea.

" Ulcer " in lung.

Example of the
corresponding symptom

Thirst, headache.
Loss of vision.

Flushed cheeks ; curved
nails.

195. id) The difference between " symptoms " and " signs."
We speak of a symptom in regard to its own intrinsic character,
or in relation to that to which -it belongs. A " sign " is that
which guides the physician to a knowledge of the real essential
nature of the disease.

It is asked : Are symptoms to disease as shadow is to object ? The answer is,
that the two are associated but are not inseparable. In other words, the symptom
is a (scholastic symbolism, of §56, sqq.) and not m.f. The term " " symptom
refers to many phenomena, some of which are really the direct consequence of the
disease, while others are only indirectly its result. This question would never
arise were it not for the custom of supposing " diseases " are entities of some kind.

(b) One disorder may originate a second. Thus colic pro-
duces syncope, or paralysis, or spasms and convulsions.

Costseus says : To the patient, " colic " is " pain." The distension is the
cause of the pain. The pain interferes with or even arrests the vitality ot the part,

THE CANON OF MEDICINE 159

and in that sense produces the syncope. Pain is : the contact of disordered
disorganised function upon the consciousness. It is a form of " touch." The
consciousness " touches " the impaired function. " Paralysis " is " loss of the
faculties of movement and sensation." "Convulsions" = "depravity" of the
faculties of movement and sensation.

There is, therefore, a certain literal truth in the general statement.

(c) A symptom may be the cause of a disorder. Thus, violent
pain causes the suffering of colic, and syncope is the effect of the
pain. The violent pain of an inflammatory mass is due to the
descent of the matters to that spot.

Costseus adds : Pain interferes with the " breath," and may even arrest it.
In consequence, a " refrigeration of the heart " takes place. That is, the tempera-
ment of the heart becomes below normal in regard to " cold." But this is a disease.
This change of temperament accounts for the syncope.

Descent of matter (inflamm. exudate) as a cause of pain. — The acridity and
similar qualities of the exudate do actually irritate the nerve-endings, and therefore
produce pain in addition to that due to tension.

(d) A symptom may be at the. same time a malady. Thus
headache is an effect of fever, but may also last so long as to
amount to a disease."

§ 170. Costasus adds : Pain such as headache may simply
be a symptom, that is, evidence of an " intemperamental state," or
" solution of continuity." But, to the patient, it is the thing ; it is
the malady. — Little does it concern the patient that there is an
underlying cause to be treated if the practitioner proves unable to
relieve his pain.

Further, persistent pain impairs vitality ; in this sense a pain is
a disease.

§ 171. Symptoms are still confused with diseases in our text-
books. Thus, "jaundice " appears amongst the diseases, instead of
being placed separately along with a number of other characteristic
symptoms, such as ascites, which is not taken as a specific disease
even by the lay. Originally, symptoms were explained in terms of
changes of quality and the like. This theoretical explanation was
abandoned owing to a degradation of (metaphysical) knowledge.
The symptoms then became " diseases." The diseases were then
investigated, and found to be more numerous than the symptoms
(which was already understood). Subdivisions were then made, and
particular diseases specified and defined, and the multiplicity of
causation emphasized. The exact succession of processes revealed
by the microscope and biochemistry was elucidated. These succes-
sive procedures are ihe evidence of " advance " and " progress." All
the while the fact is overlooked that the same processes occur in every
'' disease," and that when the whole subject, treated from pathology,
is reduced to its least common multiple that range reveals itself as
much the same as that' of ancient lore. Cf. also § 173.

(<?) One and the same thing may be at once " disease"
" symptom " and " cause." Considered in relation to the present,

160 THE CANON OF MEDICINE

it is " disease" -/considered in relation to the past, it is " cause" ;
considered in relation to the future, it is 'symptom.' —Ex-
amples : the fever of consumption is the sign of ulceration of the
lung. Considered in itself, it is the disease. Considered in its
effect, it is the " cause " of gastric weakness. Again, the head-
ache which fever gives rise to (in those cases where fever causes
headache) (esp. "meningeal disease) may remain behind (after
the subsidence of the fever) and be itself the " disease." To
particularize, the malady itself sets up inflammation of the
meninges, and this sets up headache.

2. The States of the Human Body. The Types of

Disease*
196, There are three states of the human body, according

to Galen : — .

(i) Health— -a state in virtue of which the human body
presents that particular temperament and configuration whereby
all its functions shall proceed unembarrassed.

(ii) Disease — a state which is exactly contrary to (1).

(iii) A third state which is neither health nor disease.
There are three variants of this :— (a) the health is not perfect
and yet there is no actual illness. Ex. : the state in old persons,
and in juveniles, and in those convalescent from illness. _ (b)
Both states occur simultaneously in the same member : either
in two quite different respects (as when the temperament
of a person is normal, but there is compositional abnormality ;
or in two respects which are related to one another (as when a '
person is healthy in form, but there is error in size or position of
a member ; he may be healthy in regard to two passive qualities,
but not in regard to two active ones), (c) Both states occur in
one person, but at different times of the year (as when a person
is well in winter but ill in spring).

197. Some disorders are simple, and others compound.
The simple disorders are where there is (i) one single kind

of intemperament, (2) an isolated abnormality of configuration.

The compound (composite, compositional) disorders are
where there are two or more kinds together, which together
appear as one single malady.

198. The simple disorders comprise three groups : —

1. 'Disorders of Temperament. — In this case the members
affected are formed of similar parts, but the temperament is

* Costajus believes that Chapter I of the original should come in here, the
present chapter being the real opening of this Thesis.

THE CANON OF MEDICINE

161

depraved. The term is not used unless the disorder is primarily
in these essential parts, and then applies even if composite
members are affected secondarily [i.e., temperamental disorders
are distinguished from compositional (205)].

Disorders of temperament may actually occur in any
compound members one may think of, provided these are
formed of homologous tissues.

There are sixteen kinds of disorders of temperament, as has
been already stated. (41).

2. _ Disorders of Configuration. The members affected are the
locomotive organs (the instruments whereby actions and functions
are performed). These organs are formed of similar parts.

3. Solution of Continuity and Dislocation. The members
affected have similar parts. It occurs in organs which are
instruments. The disorder is one in which the function of being
an instrument is interfered with. Such a solution of continuity
occurs at a joint ; here we see that the separate members which
go to make up the joints are not affected. The same thing
applies in the case of nerves, bones, veins.

Any malady which depends on any of these three groups is
named accordingly.

3. Disorders of Configuration.

199. These are comprised in four main groups : (i)

Errors of development (malformations), (ii) Errors in bulk,
(iii) Errors in number, (iv) Displacements.

(i) Errors of Development.

Group.

1. Errors in form.
Here the form is
changed from its
natural grace, to an
extent which impairs
its utility.

2. Errors in passages.

Subvarieties.

Deviation from a natural
straightness.

Straightness of a naturally

curved line.
Squareness where there

should be roundness.
Rotundity where there

should be squareness.

Examples.

Too wide.

Too narrow.

Occlusion.

Head broad and round, with
ossified sutures to an ex-
tent hindering mental
power.

Curved shinbones ; genu
valgum ; clubfoot.

Pupils congenitally elongate
or slit-like or small.

Great rotundity of abdo-
men.

Wide pupils ; varices ;
aneurysms ; the dilated
blood-vessels in pannus.

Small pupils ; narrowed
eyes ; stricture of trachea
or bronchi ; stricture of
oesophagus.

Of venous orifices, e.g., in
liver. Atresia (Tr.).

I 62

THE CANON OF MEDICINE

Group.

3. Errors in cavities
or sacs.

4. Errors of surfaces.

Subvarieties.

Too large (distended).
Too small (contracted) .

Obstructed and overfull.
Emptied.

The normal roughness re-
placed by smoothness.

The normal smoothness be-
comes rough.

Examples.

Scrotum.

Contracted stomach ; con-
tracted cerebral ven-
tricles in epilepsy.

Obstruction in cerebral ven-
tricles in apoplexy.

Cardiac cavities emptied of
blood by reason of ex-
cessive joy or extreme
pain.

At the orifice of the stomach;
also in lienteric diarrhoea.
Trachea ; fauces (hoarse-
ness) .

(ii) Errors in bulk, {a) Increase : as in elephantiasis,
unduly large penis (priapism) ; macroglossia. The disease
which befel Nicomachus, whose body became so huge that he
could not be moved, (b) Decrease : shortness of tongue so that
it cannot reach the other parts of the mouth _ (tongue-tie).
Atrophied and wasted members ; general " decline."*

(iii) Errors in number. (a) Increase : (a) in normal
or g an s_additional teeth ; supernumerary fingers ; (0) en-
tirely abnormal — warts, calculus, enlarged glands, (b) Decrease :
(a) in normal organs — congenital absence of a finger ; (0)
accidental — loss of a finger through amputation (accidental or
surgical).

(iv) Displacements, (a) Displacement from the proper
anatomical position. (a) Replaceable : e.g.^ hernia of the
intestine ; tremor (which occurs through a quite unnatural to
and fro involuntary movement). if) Not replaceable : e.g.,
fixation of a joint in a new position, as in gout where joints are
hardened (ankylosed). (b) Displacement from the normal
position in regard to neighbouring anatomical structures.
This results in their being too near together or too far from one
another. In such a case one part cannot move towards another
as it should ; for instance, adjoining fingers cannot touch one

* Decline. — Dhebul. — The term refers to a condition in which the body seems
to wither or fade away without obvious reason, or in spite of taking food. The term
refers primarily to the causeless losing of flesh by horses, whereby they come to be
in an iU-conditioned state. The same word would apply to the wilting of cut
flowers or the withering of plants from lack of water, or from reduction of their
vitality to such a point that they will not imbibe water any more ; that is, they
cannot be " re-vived." Such a condition in man is noted by the laity, but is only
referred to in medicine when its pathological basis is visualised ; as, for instance,
in wasting from tabes mesenterica, or tabes dorsalis.

THE CANON OF MEDICINE 163

another. Or, one part cannot be moved away from another,
either at all, or only with very great difficulty. For instance, in
the case of joints flabby because of paralysis, or in the case of the
eyelids. There may be a difficulty in opening the hands or in
opening or raising the eyelids.

§ 172. Museum- classification of errors of development.
(Abbott, 105 p. xv.)

1. Foetal structures normally not persistent.

2. Incomplete development.

3. Reduction in size (hypoplasia).

4. Reduction in number (subdactylism, etc.).

5. Persistent foetal structures.

6. Excess of size.

7. Excess in number.

8. Malposition ; aberrant structures.

9. Anomalies due to foetal disease.

4. Solution of Continuity.

200. The following members may undergo solution of
continuity.

1. The skin (and the flesh beneath it) : as excoriation,
scarification, wounds. If pus is not formed or discharged, it is
called a wound ; if a discharge of pus is present, it is called an
" ulcer." The presence of pus is due {a) to effete matters
(" superfluities ") being discharged at that spot ; for the reason
that it is weak, (b) The tissue is not able to digest all the
nutriment which is brought to it, the excess being changed into
pus.

The terms " wound/' " ulcer " may also be applied to
solution of continuity in places other than skin and flesh.

2. Bone. A fracture into two parts, large or small ; or
longitudinally in the form of a fissure.

3. Cartilage. The fracture may be in any of these three
ways.

4. Nerve. Transverse section from incised wounds ;
longitudinal, and over a short distance, as " scission." Longi-
tudinal and also extensive — in a contusion.

5. Muscle. If near the ends, or in the tendon : attrition.
If transverse : severance, or incision. If longitudinal, but small
in extent, with the formation of a deep hollow, it is called
cavitation. If multiple, with the appearance of several swellings
and hollowings, it is attrition with contusion. If the solution of
continuity is in the belly of the muscles, it is called attrition or
incision, or contusion, whatever be the direction of the injury.

i6 4 THE CANON OF MEDICINE

6. Arteries and Veins. When these undergo solution of
continuity, they are " opened." If the injury is transverse, it is
an incision ; if longitudinal, it is called fission. They may be
punctured (perforation). There may be a partial solution of
continuity, whereby the blood escapes into the surrounding
tissue-spaces, until their pressure arrests its further progress ;
this is called an aneurism.

7. Membranes (including the diaphragm) : disruption.
Note that not every member can undergo solution of

continuity with impunity. For instance, in the case of the
heart, death ensues. .

201. If one of two parts of a composite member be
separated° from the other, such that there is no actual injury to
either, it is called a dislocation. A nerve may be twisted out of
place, and this is also called a dislocation. It is also called a

contorsion.

202. When a solution of continuity occurs where there
are foramina, it may widen them. When it occurs in a place
where there are no foramina, such may come into existence.

203. Any solution of continuity, whether it be in the form
of an ulcer or the like, will heal quickly if the temperament of the
member be good. But if the temperament be not good, healing
may be delayed for a long time. Healing is specially delayed in
persons with dropsy, or cachexia, or suffering from lepra.

204. If wounds are tightly bandaged, they may end in a
very deep ulcer. Ulcers appearing in summer may last on into
winter, and exhaust the strength.

Resolution of continuity is referred to in detail later.

5. Composite Diseases.

205. Definition. — By the term " composite diseases " we
mean — no t that several diseases are conjoined — but that a
number of morbid states concur, and out of them there emerges
one single disease. This is exemplified by cutaneous swellings
of inflammatory nature (including boils, pustules). Boils are
small inflammatory masses, and ordinary inflammatory masses

are large boils.

The following kinds of morbid state go together to make
up an inflammatory mass* : (1) a disorder of temperament, this
being associated with matter ; (2) a perversion of form ; (3)
unhealthy configuration — one never meets with an inflammatory
deposit without there being disfigurement, change of size, and

* Hence the popular name for a local inflammatory condition—" gathering."

THE CANON OF MEDICINE 165

there is often displacement as well ; (4) loss of continuity.
This is the necessary accompaniment of the discharge of super-
fluities into the tissue-spaces, penetrating as they, do into them all,
and separating one from the other in order to make space for
themselves.

206. Site. — Swellings occur in soft members, and some-
times also in bone, in which case the cavities in the bone widen
and the exudate accumulates in them.

It is not surprising that a tissue which can accommodate
nutrients should also accommodate waste materials if these
should by chance penetrate into it, or should form in it.

207. Causation. — (a) The primary cause may not be
evident, the corporeal change showing that material has been
removed from one tissue to another (at a lower level). This is
called a " catarrh." (F) The material cause from which
boils and other inflammatory swellings arise may be immersed
within other humours, without being deprived of its own harm-
ful qualities.

Good humours may be discharged either by natural
processes (as, for instance, in the case of women at the times of
parturition and lactation), or by unnatural processes (as when
good blood is^ lost through a wound). The bad humours,
however, remain and continue to be harmful ; Nature then
expels them. If the discharge is by the skin, pustules form.

208. Classification of Swellings. — Swellings may be classi-
fied according to the different kinds of matter of which they
are made up ; namely according to the six kinds of material
cause — the four humours, wateriness,gas.

There are both hot and cold inflammatory swellings. But
the fact of their being hot does not say they are derived from
bilious humour or blood. Any material intrinsically of hot
nature, or any material which has become hot because of putre-
faction, can give rise to a hot inflammatory mass.

Swelling =waram=apostema=tumour (used in a general sense) ; any " lump "
or excrescence or protuberance. Intumescence, tumefaction, new-growth, nodosities
— these, are special kinds of swelling. In most passages an inflammatory swelling or
mass is meant ; waram or apostema is translated accordingly. It may be noted
that an apostema is more likely to be coloured, and to feel warm to the touch,
whereas a swelling which can be called a tumefaction is colourless and does not fee'
warm; that is, it is a " cold " swelling. (211).

209. While it is possible to subdivide these swellings
according to the humours concerned, it is better to use special
names in special cases. Thus, a mass derived purely from the
blood is called " phlegmon " ; one derived solely from bilious

1 66 THE CANON OF MEDICINE

humour is called "erysipelas." When the origin is compound,
or dual, a double name is allotted. Thus, phlegmon erysipela-
todes, if phlegmon is the chief feature ; erysipelas phlegmonodes,
if the erysipelas is the chief feature. When a collection of actual
fluid has gathered, it is named an " abscess." This may occur
in lymph-nodes (axilla ; behind the ears ; in the groins) which
are then nothing but " corrupt " matter ; and this is called a •

"bubo." , ,

210. Hot Swellings.— The following are the phases of

the hot swellings :

i. The onset. The humour makes its way to the surface,
and increases in size, until the cavity is so distended as to be
evident, ii. The rise : the size and tension increase, hi. The
acme : the height of the malady, and stationary period, iv. The
decline : . (a) stage of softening from digestion of the contents
and resolution or (b) maturation into pus* ; or (c) a conversion
into a hard or indurated mass.

211. Cold Swellings (lit. " swellings which are not hot "):

1. Composed of atrabilious humour :

i. induration (generally autumnal),
ii. cancerf (generally autumnal),
iii. glandular : scrofulous, other nodules and nodosities.

2. Composed of serous humour :

i. lax.
ii. soft glands ; and winter swellings.

3. Composed of watery fluid : e.g., dropsy, hydrocephalus ;

hydrocele, and the like.

4. Composed of gases : tumefaction ; puffiness ; distension.

Puffiness. This stands for tahabbuj (Rome edition), or tahayyuj (Bulaq) ;
cachexia (Venice edition) = tumefaction. The Latin glossary explains that it is
meant specially as that which results from liver disorder ; when it appears in the
limbs it has a different origin. The puffiness of the eyes from lack of sleep or from
too much sleep is also different.

212. The difference between the glandular form _ and the
other two kinds of atrabilious swellings. The former is either
quite loose within the tissues among which it lies, and is therefore
easily moved to and fro by the finger ; or there is adhesion,
simply to the skin (as in strumous swellings). The other two
kinds of swelling are intermingled with, and interfused with,
the substance of the tissues among which they lie.

* Note that pus is only one kind of " matter." _ .

f Cancer appears in the Canon as a disease associated with change in. the
atrabilious humour. Therefore one condition for the production of this disease
is the entry of S into the metabolic cycle in a pathological manner (cf. § 147)-

THE CANON OF MEDICINE 167

213. The difference between cancerous swelling and indur-
ation. The latter is a slumbering silent mass which destroys
the sensation (so that the part is numb), and is painless, and sta-
tionary. It may produce weakness of the part. A cancerous
swelling progressively increases in size, is destructive, and
spreads roots which insinuate themselves amongst the tissue-
elements, It does not necessarily destroy sensation unless it
has existed for a long time, and then it kills the tissues and
destroys the sensation in the part. It would seem that indura-
tions and cancerous swellings differ less as to substance than in
the inseparable accidental qualities.*

214. The hard swellings arising from atrabilious humours
are usually hard from the outset. They are often autumnal.
They often become " indurations," especially if there be san-
guineous humour present. — The same sort of change may take
place in the swellings arising out of serous humour.

215. Swellings arising out of serous humour. These are
of two varieties. They are either diffuse or circumscribed
(nodular). The difference lies in the fact that the latter form is
discrete among the surrounding tissues, whereas the other form
is intermingled with them, and is therefore not discrete, but
diffuse. Swellings formed of serous humour often arise in
winter (the rainy season, or time of stormy weather). (Even) if
they are " hot," they are white in colour.

216. The difference between soft glands and " ganglia."
The latter are more adherent to the surrounding tissues ; they
feel nodular to the touch ; they always slip back to the original
position after manipulation ; but they may be dispersed by cer-
tain strong medicaments, without compression, and then dis-
appear permanently. They are often produced by toil. The
application of a very heavy weight such as lead may disperse
them.

217. Swellings arising out of serous humour vary in
consistence according to the density of the contained fluid.
They may be soft, thin, lax, or hard, or resemble the atrabilious
type of swelling, or resemble the gaseous form. Tenuous serous
humour flows down along the course of the nerve-fibres, and
so reaches the muscles beneath the epiglottis and larynx.

218. Watery swellings. Examples : dropsy, hydrocele,
hydrocephalus, and such-like. [Cysts.]

219. Gaseous swellings. These are of two different kinds:
tumefaction ; inflation. These differ both in essence and in

* Hence some cases of " Induration " may have been what is now called
" scirrhus."

Z 68 THE CANON OF MEDICINE

mode of commixture. In tumefaction, the gas is intimately
mixed with the substance of the tissue. In inflation it is aggre-
gated 'tense, tumescent, and discrete from the substance of the
tissue. The former feels soft ; the latter feels more or less

220. Papular swellings. These show the same subdivi-
sions as inflammatory swellings in general. They are formed of
(i) blood or sanguineous humour (true pustules) ; (2) purely ot
bilious humour : miliaria, sudamina, certain forms of eczema ;
(3) both serous and atrabilious humour (morbilh, myrmecia,
clavus, scabies, warts, and the like) ; (4) watery fluid (bullae,
vesicles) ; (5) gaseous material (emphysema). _

The points of distinction which apply in regard to the kinds
of pustules will be adequately dealt with in the fourth Book,
should Allah be willing for its accomplishment.

6. Disfigurements

221. There are some states which are not " disease," but
are classed as such. These are conditions in which the beauty
of the form of the body is impaired, either in respect of hairiness,
colour, odour, or form.

1 . Affections of the hair. Alopecia ; stumpmess ; scanti-
ness ; shortness ; scission ; fineness ; coarseness ; curliness ;
lightness ; colour-changes, such as greyness.

2. Affections in which there is an abnormal colour of the body.
i. Due to an intemperament :

(a) material : jaundice.
\b) non-material :

(1) very cold intemperament : chalkiness ;

(2) very hot intemperament : citron-yellowness,
ii. Due to extraneous agents : scorching sun, extreme

cold ; much exposure to wind ;

iii. The presence of unnatural colours in the skin : [a)
brought into the skin (vitiligo nigra), (b) arising in it (freckles,

iv. Relics after the healing of scars : pock-marks • old

ulcers. , r

1 Affections associated with bad odours ; Ex. : rcetor or

the mouth, or objectionable odour of the whole or of portions

of the body. . .

■ 4. Disfigurements. Ex. : Great emaciation ; excessive
bulk ; undue thinness and fatness. (Malformations.)

" Excessive corpulence and excessive leanness are especially worthy of con-
demnation " (Charaka-Samhita 155 : i. 233).

THE CANON OF MEDICINE 169

7." The Stages of Disease

222. Many diseases show four stages — onset, increment
acme, and decline. These are distinct from the phases of health'

In speaking of " time of onset," and " increment," we do
not wish to convey the idea that there are two extremes during
which a. state of disease is indiscernible. Each stage can be
detected by the senses, and each has its own characteristic signs.

1. The " onset " is that period of time during which the
disease is becoming manifested, and its characters are commenc-
ing to develop. There is no evident change in degree.

" ****?* " djpase belongs here ; " occulta " as compared with the other three
stages, which are declared," " visibilia."

c M1 2 - The , " i^ement " is the period during which the degree
or illness is hourly becoming more and more decided.

3- The " acme " is that period during which all the
characters of the illness have become manifest, and remain so.
.4- The "decline" (defervescence ; terminal stage) shows
abating of the signs of illness ; and the further this period
advances, the more nearly is there freedom from the symptoms
of the diseases. r

These stages may be applied both to the illness as a whole
and m regard to each of its component attacks or paroxysms'
In regard to the whole course of the disease, they are called
" general " ; in regard to each of the attacks which occur
m its course, they will be called " special " or " particular " or
" individual " phases.

8. Concluding Remarks on Morbid States
223 Diseases are named : (1) according to the member
affected (e.g. pleurisy, pneumonia, sciatica, podagra, nephritis
arthritis, ophthalmia, etc.) ; (2) according to the chief symptom
(epilepsy, spasm, tremor, paralysis, palpitation, cephalalgia
otalgia, cardialgia, odontalgia, neuralgia; etc. (3) From the
originating humour (e.g. atrabilious disorder) ; (4) from resem-
blances to animals which the disease produces (e.g. leontiasis
elephantiasis, satyrism) ; (5) from the first historical example of
the disease ; Telephic ulcer— Telephus, son of Hercules
wounded by Achilles' spear, but healed by its rust ; Chironia
ulcer— Chiron, the first who successfully treated ulcers medically
(6) according to the substance and essential nature of the disease
— fever, inflammatory swelling-.

224. Galen classified diseases into : (a) manifest or
evident to the senses ; (b) hidden, or internal : (i) easy to recog-

I? o THE CANON OF MEDICINE

nize (e.g. gastric pains, lung pains) ; (ii) difficult to recognize
because not evident to any of the senses (e.g. diseases of the liver
or of the air passages within the lung) ; (in) only discernible
bv careful judgment (disorders of the urinary passages).

' 225 Diseases may occur in single members or in more .
than one*. In the latter case there are the following possible
relations : (i) association by natural connections ; ex. : stomach
and brain, which are associated through nerves ; the uterus
and breast which are connected by the veins.

(ii) • One member is the channel for the other. 1 hus, the
groin is the natural channel for inflammation to travel into the
leg The weaker of two of so related members will take up ;
the excrementitious matters from the stronger ; for instance,
the axillary region from the heart. #

(iii) Simple contiguity ; e.g. the neck and the brain.

(iv) One member initiates the function of another. *or
instance, the diaphragm is concerned in the drawing of air into
the lungs (v) One member is the servant of another ; thus
the nerves serve the brain, (vi) Some third member is associated
with two related.organs. Thus, the brain is related to the kidney,
and both these organs are related to the liver (Disease m one
is likely to have deleterious effects on the others.) (vn) Vmous
circles Disorder of the brain affects the activity of the stomach
and impairs the digestion ; consequently the stomach supplies
morbid vapours and imperfectly digested aliment to the brain
so increasing the disorder of the brain. Hence from the original
illness, the malady spreads and continues, and runs in a circuit.

226. There are the following six degrees, ranging from.

health to disease :

i. Blameless health.
1. Not absolute health.

7 A state neither of health nor of disease, as people assert.
% Potential illness ; where the body is on the verge of
illness.

5. Slight ill-health.

6. Declared disease.

227 Diseases are curable or incurable. A curable
disease i°s one which offers no resistance to treatment. An
incurable disease is one in which there is some impediment to
complete cure, so that whatever the doctor applies, the desired
effec? is not reached. For instance-headache which is due to
" rheumatism." A disease is more likely to be curable whenthe
temperament, the age, and the season are in proper relation..

THE CANON OF MEDICINE i 7 i

If not, there must be a serious causal agent at work. One
can only hope to cure . or 5 disperse the diseases of one season
during the contrary season.

228. Some diseases turn into new ones, and so themselves
disappear. This is very satisfactory. One disease becomes the
medicament for curing another. Thus, quartan malaria often cures
epilepsy [cf. G.P.I.] also podagra, varices, and arthralgias.
A spasmodic disease may be cured by scabies, pruritus, and
furunculosis. A certain type of diarrhoea is cured by inflam-
mation of the eyes. Lienteria cures pleurisy. Bleeding piles
removes atrabilious disorders, including sciatica, renal and
uterine pain.

But the passage from one disease to another may be a serious
matter. For instance, when an empyema spreads 'into the sub-
stance of the lung ; when meningitis becomes lethargia.
229. Transmission of disease from -person to person.

A. Transmission by infection, (i) From one house to an
adjoining one. Here belong, lepra, scabies, variola, pestilential
fever, septic inflammatory swellings and ulcers ; (ii) from a house
m the wind-track to another ; (iii) when one person gazes
closely at another (e.g. ophthalmia) ; (iv) fancy : e.g. when a
person's teeth chatter because he thinks of something sour ;
(v) such diseases as phthisis, impetigo, leprosy.

B. Hereditary transmissions* Vitiligo alba ; premature
baldness ; gout : phthisis • lepra.

Place in Family as a factor in the causation of disease {Lancet, 1928).

C. Racial transmission.

D. Endemic transmission. The sweating sickness of
Angha ; elephantiasis in Alexandria ; aurigo in Apulia •
endemic goitre, and many the like. '

230. Do not forget that weakness of members, and a frail
body may supervene upon intemperaments.

§173. This classification of the types of disease still holds good to-dav
^trpXTog^alVndS^ dlferent ' b6CaUSe n ° W made more definite ^ in accord
~t ^ S ° m t confusion as t0 the scope of the various terms still exists even in the minds
a °i r t ^ aSe n W 5 h0 are n ° lo ^ students. Clinical and pathological conceptions d" not
"^fLt " P a + ° n the ° ne hand ' there is an underlying endeavour to specify
rl ,S'' and + *? se Parate out new entities in accordance with variations in the
? ™ i manifestations In pathology, the distinction between general and special
is more clearly adhered to, and the latter is described as much as possible according
to the former— which is proper. s

„i -^ J e S ard t0 an actual case before us, however, the pathology cannot be
elucidated at once ; the clinical manifestations therefore receive the chief con-
sideration. But such manifestations are limited in range, are of general character
(universal, not particular), and should rank with genera in natural history the
pathological character or process would furnish the specific name. Clinically,

1 72 THE CANON OF MEDICINE

diseases naturally comprise swellings, deformities, discolorations displacements,
ulcerations, various solutions of continuity, aches and pains, and the like. Patho-
logically, there are only four main groups of lesions— inflammations, new-growths,
nutritional changes (degenerations and hypertrophies), and errors of development.
(The short list presented by Avicenna is not a real fault, when considered from
such a point of view.) If such a system cannot be allowed either by 'academic
medicine or the laity (who insist on a " name " for a disease ) it has at least the
advantage of enabling one to visualize from the first what is important to the patient
and to concentrate on it. .

The opposite procedure— that which rules the day— is that of describing
diseases in all their forms and types, typhoid fever being awarded the crown The
literature is always receiving reports on new types of disease. This method has the
advantage of being capable of unlimited extension, for the number of types is (as
should be obvious) exactly the same as the number of individuals affected thereby.
In other words, all these types are simply the expressions of the individual s make-up
and have nothing whatever to do with the infective organism, except m so far as it
varies in virulence (i.e., in the composition of its " excreta "). ^

The idea that treatment cannot be correct unless the disease is correctly
named is also very widely spread, and has the same effect— that of blinding the mmd
to the real simplicity of truth. The unknowing abhors simplicity ; he ever seeks to
" improve " — that is, to introduce more and more complexity.

'W 1 '

THESIS II.— THE CAUSES OF DISEASE
ETIOLOGY

"Correlation, adverse or absent or excessive, between time, mental faculties
and objects of the senses, constitute in brief the threefold causes of disease affecting
either ^the body or mind." — (Charaka-Samhita 1 * 6 , i. 5.)

" If the activity of the life-principle takes place in a harmonious and regular
manner, unimpeded by any obstacles, such a state is called ' health.' If its activity
is impeded by some cause, and if it acts abnormally, or irregularly, such a state is
called disease. — (Paracelsus", p. 181.)

i. Definition of Terms

281. There are three groups of causes
of those states of the body which have been
referred to as : health, disease, a state
intermediate. These groups are : (i)
Primitive, or extra-corporeal causes. These
befall the body from without (trauma, heat,
cold). (2) Antecedent causes. These befall
the body from within (repletion, starvation).
(3) Conjoined causes. Here disease is pre-
sent only as long as two causes occur at the same time. When
either is absent, the diseased state comes to an end (e.g. sepsis,
in fevers).

The primitive causes are extra-corporeal ; namely : (a)
from exterior agents, such as blows, exposure to very hot air,
use of hot or cold viands ; (b) from the mind, which is here
considered as distinct from the body. Here belong the causes
of states of anger, fear, and the like.

Other examples : privation of food, shelter, covering ; environment (monotony
solitude, restraint, neglect, subjection, and their opposites). These are predisposing

C3/QS6S.

Resemblances. — The primitive causes resemble the ante-
cedent in that there is a certain intermediate condition between
each and the three states of the body named above. The
primitive causes sometimes resemble the conjoined, in that there
is no intermediate condition between them and the three states
of the body. The antecedent and conjoined causes resemble
one another in both being corporeal, or humoral ; that is, either
temperamental or compositional.

173

I74 THE CANON OF MEDICINE

Differences.— The antecedent differ from the primitive
causes in being corporeal , and in requiring an intermediary
between them and the bodily state. Such an intermediary is
not necessary in the case of the primitive causes.— The conjoined
causes differ from the primitive in being corporeal, but without
an intermediary between them and the bodily state. An inter-
mediary may occur, but is not essential in the case of the primitive
causes.— The antecedent differ from the conjoined causes in
that with the former the state does not become immediately
manifest, but only after a number of other intermediate causes
have come into operation, these being nearer to the state than
are the antecedent causes.

The above groupings of causes are the expression of a mode of
thought now foreign to us. We seek more practical statements and
rightly But when he thinks of causes, Avicenna goes back to
fundamentals. This patient is before him, and the illness owes its
origin to external factors which that patient cannot escape— the
atmosphere, the weather, the climate, the drinking-water, the soil
over which he lives and works ; or to factors operating within the
body, producing aberrations in the physiological processes.

The external factors naturally fall under the categories of the
four elements (five, if we include " aether," represented by sunlight),
and the memory is securely aided by thinking of each in turn.—
The internal factors are classified according to the qualities— heat,
cold, moisture, dryness. These also serve as aids to memory since
many aberrations in physiological processes amount to disturbances
in these several qualities in the different parts of the body.

Changes of vitality as causes of disease are not here specified
because they are secondary to the other causes It is true that
disease is evidence of loss of vitality, of loss of radiance of the
" breath " but this is the effect of " antecedent causes— repletion
with humours ; depletion of humours ; and these again can be
traced back to-interactions of qualities and changes in the proportions
of the " elements."

The following table is added for clearness : |

Name of
Cause.

i. Primitive.

2. Antecedent.

3. Conjoined...

Nature.

Non-corporeal.

(1) Corporeal (i.e.,
a humour).

(2) Temperamental.

(3) Compositional.

Corporeal.

Relation to
bodily state.

May be direct, or may
only be through an
intermediate state

Is indirect, via an in-
termediate state.

Examples.

Solar heat.
Violent exercise.
Heating articles of
food (e.g., garlic).
Sadness.

Wakefulness. Blows.
Cataract. Fever.

Direct ; immediate.

Suffusion of the orbits.
Lachrymation.
Repletion in fever.

Blockage of an aper-
ture by a humour.

Blindness from ob-
struction of the optic
nerve .

Sepsis with fever.

THE CANON OF MEDICINE

l 1S

232. Essential causes are such as pepper, which warms ;
opium, which cools. Accidental causes are such as cold water,
which warms because it closes the pores of the skin, and hence
the heat is retained ; hot water, which cools because it opens
the pores and liberates the heat ; scammony which cools by
expelling the calefacient humour.

An essential cause is one which alters the." nature " ; that is, that on which
the primary qualities of the body (heat, cold, moisture, dryness) depend.

233. ^ It does not follow that a causal agent will alter the
body even if it reaches it. Before the agent can act one of three
conditions must be fulfilled, (i) The agent must be powerful
enough ; (2) the preparatory power of the body must be ade-
quate ; (3) there must be an appropriate time-factor. The agent
must be exposed to the causative agent long enough for the
latter to act. The states of the causes vary in their results. One
single causal agent may give rise to quite different diseases in
different persons, or at different times.

The_ Time-factor.— The time occupied before a given agent can produce its
effect varies with different individuals, just as some persons have a long digestive
time-factor and others a short one. This was spoken of very long ago (Charaka 155
ii. 793) ; the lesson being, in the case of digestion, that the number of meals per
day should depend on the time-factor and not on popular custom

A. UNAVOIDABLE CAUSES OF DISEASE

(i) Extracorporeal

2. The Atmospheric Air and its Influence within the

Body

■ IR (234) is an element which is in our body and
in_ our breath (ruh). It is also continually
being contributed to the breath. It is the
agent which modifies the breath, not simply as
element, but in virtue of its constructive and
attempering nature.

235. We have made it clear already, and
emphasize it again here, that the term " breath " is not synonymous
with what philosophers (and theologians) term " soul"

236. There are two processes whereby the breath reaches
its attempered state from the air — namely depuration and ven-
tilation. Ventilation is the means whereby the temperament of
the breath is modified in respect of the undue warmth which is

i 7 6 THE CANON OF MEDICINE

usually the effect of condensation and imprisonment of the breath.
(By temperament we mean that relative temperament which has
been denned for you.) This attempering is attained by means of
the air drawn in at the lungs and the pores of the skin, and by
means of the distribution of that air through the arteries by means
of their pulsation.

237. Compared with the temperament inherent in the
breath, the air around us is very much cooler than it is compared
with the temperament arising from the imprisonment or con-
densation of the breath. When the outer air enters the breath,
it drives it on and mingles with it, and so prevents its trans-
formation into the astringent fire-element ; for such a transform-
ation would render the temperament of the breath faulty and
unfitted for receiving the impressions of the sensitive soul
(i.e. for maintaining life), and would interfere with the dispersal
of the moist vapour of the substance of the breath.

238. Depuration is the process going on during expiration,
and by it the separation of the fuliginous vapour in the breath is
secured. The fuliginous vapour is to the breath what superfluous
humour is to the body, and it is expelled (as bad air). During in-
spiration, the air enters into, pervades, and aerates the breath ;
during expiration, the breath is purified into the air. (In this way
the temperament of the breath is maintained.)

239. When the air is first drawn in, it necessarily cools
the breath, but after the air attains the quality of the breath,
through continued contact with its heat, it ceases to be an
adjuvant, and is superfluous. Hence new air is needed, and
when breathed in supplies the place of the other. The old air
must be expired in order to give place for the new, and at the
same time remove with it the superfluities of the substance of
the breath*

240. As long as the air is attempered and pure, and has no
substances admixed which would be contrary to the temperament
of the breath, health will come and remain. Otherwise the
contrary occurs.

241. The air is liable to natural as well as non-natural
changes, and may even undergo preternatural changes. The
natural changes are those of the seasons. At every season the
air changes to a new temperament.

* It appears that the idea of gaseous interchange within the lung was not
grasped What we know as " residual air " comes to be what Avicenna speaks of
as "breath " (ruh). Hence the description in the text is right m idea, but lacking
in exactitude.

THE CANON OF MEDICINE I?7

/M n ^i US l e markS J^* the air is diffe rent in character (a) at the seasons of the
year (6 1 at the changes of the moon, (b >) at the rising and setting of the stars A^inerpf

(fl) NATURAL MUTATIONS

3. The Influence of the Seasons on the Atmosphere

242._ _ The word " Season " has a different meaning for
the physician than for the astronomer. According to the
astronomer, there are four seasons, which are reckoned according
to the position of the sun in the zodiac. According to the
physician, spring-time, in temperate climates, is the time when
warm clothes are less necessary, and yet no precautions are
required against heat. The trees begin to leaf at this season.
It is the time of flowers and leaves, and the beginning of the
formation of fruits. To be more exact, it is the portion of the
year between (or about, or slightly before, or slightly after)
the vernal equinox and that at which the sun has reached the
middle of Taurus.

Autumn is the opposite portion of the year in our latitude.§

§ This chapter is taken by Andreas de Alpago Bellunensis as the nmnf +w
Avicenna was a native of Persia, (cf. footnote to 369). eUUnenSls as the P roof that

_ It is the time of change of colour in the leaves, and the
beginning of their fall from the trees.

later ^ ^^ C ° UntrieS S P rin £ ma ^ come sooner and autumn

The summer and winter, from the point of view of medicine
are the portions of the year remaining— and the interval between
spring and autumn is much shorter than that between autumn
and spring.

Summer is the whole of the hot season, and winter the whole
of the cold season It is the season opposite to summer, beincr
less or greater m duration according to the latitude.* &

" weak"Ta e sons nd "^ "* ^ " Str0ng " SeaSOnS < S ^ and autumn are the

243. The temperament of spring is equable, and not hot
and moist as some think. The proof of this rests with natural
philosophy.

The temperament of summer is hot, because the sun is

* This passage is slightly rearranged.

i 7 8 THE CANON OF MEDICINE

nearly vertical, over our heads, at this period. The power of
the rays of the sun may be. thought of as being concentrated in
summer because instead of being refracted they form only a
very acute angle, or are reflected back along the line of incidence
itself. The effect is different according as the solar ray is axial,
like the -axis of a column or pyramid (in which case the ray is
thought of as coming from the centre of the sun into an exactly
opposite spot on the earth's surface), or is oblique. The axial
rav is stronger because its impression is added to by the incoming
rays from all other points. The oblique rays are the weakest
(because in this case rays from other points do not join and add
to them). In summer we are exposed to rays almost or quite
axial. This is the longest season in our (southerly) climes. In
winter the rays are nearly circumferential (tangential, oblique).

244 In summer the light is very intense, and yet the sun
is more distant from the earth, for the sun is on the increase
However, I discuss the subject of the distance or nearness of
the sun in the astronomical section of my book on mathematical
philosophy. The proof of the intensity of the heat and of the
lio-ht of the sun is set forth in my book on natural philosophy.

b 245 Influence of summer. Summer makes the air hot and
dry, because (i) its great heat disperses the water vapour ;
(2) it attenuates the " substance " of the air, and makes it more
like " fire " ; (3) there is little in the air at this season to separate
out as rain or dew. .

246. Influence of winter. Winter makes the air cold
and moist, for contrary reasons.

247= Influence of autumn. In autumn, the heat subsides
and the cold is not yet'at its greatest because we live at a latitude
where the rays are between the equatorial axis already referred
to and the circumference. That is why the temperament of the
air is between hot and cold, but not between moisture and dryness.
When the sun has rendered the air dry, how could there remain
behind in the air any humectants which would counteract the
source of desiccation ?

248. A state of the air tending towards coolness is not
like one tending to moisture, because the change to cold is only
slight, whereas the change to moisture is further. The change
towards moisture which coolness induces is not as easily effected
as one towards dryness, which heat induces. The latter is facili-
tated by heat because heat itself is a drying agent. Coldness is
not a humectant. Humectation is facilitated by a certain degree
of heat provided there is some substance present which possesses

THE CANON OF MEDICINE 179

a certain degree of coldness. A certain amount of heat allows
evaporation, but does not disperse (water vapour) ; and there
is a certain amount of cold which is inadequate for bringing about
inspissation, cohesion, or union.

249. Consequently, the state which enables the air of
spring to remain at the same degree of moisture as in winter is not
like the state which enables the air of autumn to remain at the
same degree of dryness as in summer. The moisture of the air
in spring is attempered by heat as much as the dryness of air
in autumn is not modified by cold. Moisture and desiccation,
therefore, are alike in regard to the action of " habit " and
privation but not in regard to the action of their respective
contraries. For, in this case, desiccation is simply " destruction
of- moist substance " ; but humectation is not " destruction of
dry substance," but " acquisition of moisture."

250. In speaking here of air as being "moist" or "dry"
we do not, of course, refer to " form " or " natural quality."
Such a question is remote from our present purpose. In calling
air " moist " we mean that much aqueous vapour is admixed
with it, or that its density has reached that of aqueous vapour.
In calling air " dry," we imply (i) that the aqueous vapour
formerly present has been dispersed, or (ii) that the air has
become rarefied or attenuated until it comes to resemble the
substance of Fire, or (iii) an air with which earthy vapours
(which resemble Earth in being dry) are admixed.

251. Consequently, the moisture in the atmosphere
which remains over from the winter is lessened in spring bv a
certain amount of heat accruing to it by the fact that the sun is
approaching the middle of the heavens, and coming to be nearly
overhead. But the dryness which remains over from the autumn
does not encounter any moisture from the approaching coldness
of the winter.

252. Further, would dry things become moist as quicklv
in cold air as moist ones would become dry in hot air, supposing
the ratio between the cold and coldness to be about the same as
that between heat and hotness ? Obviously there would be a
difference.

253. A third and better argument is that moisture cannot
remain longer in hot air than in cold unless it were continually
being reinforced by further additions of watery vapours. Dry-
ness, however, needs not such continual emanation for its main-
tenance.

254. The reason why moisture disappears from bodies

i8o THE CANON OF MEDICINE

exposed to the air, or from the air itself, unless there is a continual
reinforcement with further moisture, is that air is only cold in
comparison with our body/ It is not sufficiently cold in the places
we inhabit to enable the moisture to be dispersed from the
atmosphere. It is the power of the sun and the stars which
disperses it. Consequently, though the supply of _ moisture
ceases, the dispersal goes on until a state of dryness is rapidly
reached.

255. The atmosphere in spring. In spring, there is more
loss by dispersal than by evaporation. The reason is (i) there
is little heat, and that is dispersed widely in the atmosphere ;
(2) much heat is shut up in the bowels of the earth. Hence
rarefied vapours are continually being breathed out towards the
earth's surface.*

256. The atmosphere in winter. During winter the amount
of heat concealed within the earth is very great — as is proved in
treatises on natural science — whereas there is only a negligible
amount of heat in the atmosphere. So there are two factors which
together contribute to moisten the air — sublimation and con-
densation. This is the more so, because the substance of the air
in winter is so cold that it becomes more dense, and adaptable
for evaporation.

257. In spring, attenuation (dispersion) in the atmosphere
exceeds evaporation. There is much less heat concealed in the
earth. This is clear from the fact that something suddenly
comes to the earth's surface at this timet which is more potent
than the evaporating or the rarefying agent. This great access
of material delays the evaporating process, and brings the
(moisture) longer into contact with the abundant atmospheric
heat ; and this completes the dispersion of the moisture.

This is the chief explanation of the fact that the vernal
air fails to retain the bulk of the winter moisture, and that the
autumnal air fails to retain the bulk of the summer dryness — ■
apart from other reasons over and above what we have named.

Furthermore, there is not enough material to replace what
has been sublimated and rarefied. The result is that the nature
of spring necessarily tends to an equipoise between moisture and

* Note the accuracy of this conception.

The fancy or j est that summer -heat and winter-cold are the result of the
greatness of the boiling of ' Hell ' (i.e., the interior of the earth) makes a breathing
twice a year, expiring in summer and inspiring in the winter " (Night, 487, Burton)
may be here recalled. . ,,

t " The vapours of the sky descend, and vapours rise up out 01 the eartn ^
(in spring). "The two co-operate in the work of renascence of vegetable hie
(Li Ki, IV, i. 14).

THE CANON OF MEDICINE 181

dryness, as much as it does to one between heat and cold. Still,
one cannot deny that in spring there is at first a tendency to
a certain degree of moisture. But in spring the moisture is
nearly at equipoise, just as in autumn the dryness is nearly at
equipoise. Even if there is in autumn not an exact equipoise
between heat and cold, it will not be far from that, because in
autumn the periods of the day just before and just after noon are
like those in summer. The autumnal air, you see, is very dry,
and can readily become warm and fire-like, summer having
already disposed it to be so. But the nights and morning hours
in autumn are frosty, owing to the obliquity of the sun's rays, and
also_ because the tenuous matter in it is well disposed to undergo
infrigidation.

Spring air has these two qualities in almost exact equipoise,
because its^ air does not take up the heat and cold which the
autumnal air so easily receives. That explains why the autumn
night is not very different from the autumnal day. And if
anyone should ask for why is an autumn night colder than a
spring night, as one would expect the atmosphere to be then
hotter, because it is so attenuated — he may have the reply that
extremely attenuated air becomes hot or cold more quickly,
exactly as does extremely rarefied water. For, if vou heat
water> and then wish to freeze it, it will do so more quickly than
cold water would, because the cold penetrates more easily
between the particles separated from one another by the pre-
ceding heat.

258. _ The human body is not as sensitive to the cold of
spring as it is to that of autumn, because in spring the body
passes from a coldness to which it is already acclimatised, to an
increasing warmth. In autumn, the reverse is the case, for
after being relaxed by the summer heat, the body is suddenly hit
by cold ; this in spite of the fact that autumn approaches winter,
whereas spring recedes from it.

259. Change of seasons has to do with the kind of diseases
peculiar to each climate. Consequently the prudent physician
will carefully study his own climate (atmospheric conditions
day by day and month by month) and country in order the
better to treat the diseases and maintain his patient's health by
an appropriate mode of life, and (in order the better to choose)
the regiminal measures appropriate to that climate and
country.

260. Sometimes one day of a season is like some one day
of another season ; and sometimes it is not. Some days in

1 82 THE CANON OF MEDICINE

winter are spring-like ; some spring days are summer-like ;
some days in autumn are hot and cold during the course of a
single day.

§ 174. The changes which the seasons produce on the human
body are ascribed in this chapter at least in part to the changes which
the seasons produce in the ground itself. We are introduced to
the idea of " ground-air," " ground- water," " ground-fire (mod.
ground-temperature). That which the Canon here hints at is
found to be entirely accurate in the light of modern investigations.

8 175 Movement of ground-air. In the interstices of the
soil there is an abundance of " vapour," which moves in and out of
the earth into the atmosphere, as the ground-water moves up and
down. We may rightly picture the earth as a huge lung. It
exhales ground-air into the air we breathe, and if the former is
humid, owing to a high ground-water level, the exhaled air will be
" damp " • if the temperature of the earth be low, the exhaled air
will be cold ; if the ground-air be polluted the air we breathe will
become fouled. The conception of the earth as a lung is given in
almost those very words by Avicenna (255).

§ 176. Movement of ground-water. The ground-water may
move merely up and down, or it may travel horizontally even to great
distances. Its height varies with the rains, the season, the nature
of the rock beneath, the character of the subsoil, and the presence of
vegetation (crops, undergrowth, woodland, forestland). The move-
ment up and down may be compared with tidal movements. The
"waters under the earth" move, as do the seas. Clearly, then,
floods and droughts, swampland and gravelly land, all have wide
effects. The interference with vegetation' also alters natural con-
ditions, whether beneficially or detrimentally to human welfare.
Lane-Notter (Enc. Brit. 25, p. 348), states that it has been estimated
that an acre of cabbages will absorb from the land, and transpire
from its leaves more than ten tons of water per day, when the weather
is fine. The destruction of trees arrests the upward movement of
ground-water, which previously was carried high up into the air
as if by so many chimneys, and so affects other places at considerable

c\\ sf3.11.CGS

§177. Practical bearing of these facts. Innumerable living
things pass the whole, or part of their lives in the ground-water.
They are carried along with it, both to the surface, and horizontally
underground, possibly to great distances. The following groups
may be specified : (1) Bacteria. These are derived from (a) the
earth's surface from refuse in the neighbourhood of habitations, from
excreta, trade-effluents, slaughter-houses, (b) deeper strata: cess-
pools, which do not necessarily filter off the organisms. (2) Protozoa.
(3) Moulds and spore-bearing organisms generally. (4) Inverte-
brates of many orders.

These all flourish according to the presence of putrefactive

THE CANON OF MEDICINE 183

matters in the soil (vegetable or animal), according to the ground-
temperature, and according to degrees of anaerobic state (which has
to do with cycles of development).

" The earth, is a great stomach, in which everything is dissolved, digested and
transformed, and each being draws its nutriment from the earth; an I elch living
being is a stomach that serves as a tomb for other forms, and from which new form!
spring into existence."— (Paracelsus, Paramirum" p. 205.)

Organisms gain access to the human body (a) directly from the
surface soil, from the drinking water, from insufficiently cleansed
vegetable foods, m partly decayed vegetables or vegetables which have
become stale m the markets, from the inhalation of infected dust
(especially the dust of earth pulverised by being parched in times of
drought), (J,) indirectly, by contamination of food by insects whose
larvae infest the soil to an extraordinary extent ; by use of vegetables
infected by invertebrates which themselves harbour pathogenic
organisms. b

§ 178. Diseases associated with ground-water. Damp soil
favours putrefaction, with ultimate pollution of the air Phthisis is
favoured m such localities. When the soil is actually wet, from the
rising of the ground-water, typhoid epidemics have been noted
(Pettenkofer). Fleas on rats which burrow into soil polluted by
plague-infected ground- water become infected themselves.
n 1 J : l 9 'r Diseases associated with variations of earth-temperature
Cold soil favours bronchitis and other chest complaints Warm soil
favours the multiplication of certain organisms— those which
flourish best at certain temperatures, and anaerobically. ^Favoured
by admixture of the soil with manure.) ^

§ 180. The subject is therefore plainly of importance both in
regard to the study of pandemics, epidemics and endemic diseases
and m regard to the daily condition of the individual patient, the
progress of his disease, and even the exact form which a disease takes
in his case. As Avicenna says, the practitioner would benefit by
noting the successions of weather-changes, the type of the season and
the seasonal cycles, especially interpreted in terms of movements of
the water, air, and " fire " in the earth.

4. The Influence of Seasonal Changes on the Body
261. When a season is harmonious* for a person of
healthy temperament, it is appropriate for him, but not so if the

x, cct " ! ia ™ onious -''— Cf. " conformity with the laws of nature '* (Li Ki » VI
P l 535) ' + t£ case the season is considered as the variable, and the human tem-

perament the constant. But it may be noted that the whole of our life is a matter
of conformity with the laws of nature," from highest to lowest. If the ''Govern-
ment conforms in all respects, thus exhibiting the Great Conformity— requiring
m o S lH r ^ mdS a + f M a 1 6r wills ~ and if e ach individual in turn conforms! the E?
I°S inSn,i e ^ eal State - rhe *PP^°K ^ regard to the incidence of Leal
m the individual being is very wide, and this section of the Canon becomes sue-

fsScIaVo nwi n th S 1 t: reStmg "^ Whm *" QaSSiC jUSt 1 uoted is «Sd L

l84 THE CANON OF MEDICINE

person is of unhealthy temperament. But* if deviation from
equipoise be marked, then the season will be harmonious or not
correspondingly, but the person may become debilitated.?
When a season is appropriate for a person of unhealthy tempera-
ment, the contrary holds.

262 When the nature of two seasons at the commence-
ment is opposite to that at their termination, and yet the altera-
tion from the mean is not great (because not of long duration),
as, for example, when a southerly winter is followed by a norther-
ly spring the second season will be more beneficial to the human
body than the first, and will attemper the body. This is because
the northerly spring is opposite in action to the southerly winter.
If the winter be very dry and the spring very wet, the latter
modifies the dryness of the former. But if the spring is not
very humid and does not last long, then its modifying moistening
influence will not be deleterious. _ _ .

263 A single seasonal change is less injurious to lite than
are repeated changes— supposing the change m question is
liable to prove mortal, and not one which reverses a previous

264 Among the temperaments of the atmosphere one
that is hot and moist is more favourable to putrefactive pro-

cesses.

265 Atmospheric changes are common in some regions,
especially in the depths of the valleys ; they are only rare on
hills and high mountains. .

266 It is better when seasons are normal in character ;
it is better that summer should be hot and the winter cold ; so
with each season. If seasons are not normal in character,
serious maladies will arise.

267 If all the seasons in one year are of uniform quality
(for instance, wet, dry, hot, cold, all through the year) it is a bad
year ■ there will be many diseases in conformity with the quality
of the year. The subsequent seasons will be fortunate, lr a
single season can arouse much illness of corresponding type, how
much the more will not a whole year arouse ? _

268 A person of phlegmatic temperament is liable to
develop epilepsy, paralysis, apoplexy, trismus, convulsions and

the like, in a cold season.

269 A person of choleric temperament may develop
delirium 5 S mania, acute fevers, acute inflammatory swellings tn a

* i.e., Taking the human nature as the variable, and the laws of nature as the
constant^ ■ ^ non _ proportional season would make a very non-equable person weak.

THE CANON OF MEDICINE 185

hot season. How much the worse would it not be if the character
of that season persisted throughout a whole year ?

270. _ With a premature winter, winterly diseases come on
early. _ With a premature summer, summer diseases arise early.
The diseases of the corresponding season will change accord-
m gty- .

271. An unduly prolonged season predisposes to many
illnesses, especially in the case of summer and autumn.

272. Note that the effects of the changing seasons are not
due to the season itself, but to the quality which is changed along
with them, for this exerts a marked effect upon the states of the
body. A change from heat to cold in the course of a single day,
produces a change in the body accordingly.

273. A rainy autumn followed by a temperate winter (not
without some cold, and yet not too cold, considering the geo-
graphical region) is more healthy. A rainy soring followed by
a moderately rainy summer would be more likely to be healthy.

See also 581, where the effect of the seasons on the pulse is discussed.

5. The Properties of Healthy Air

274. The substance of the air is good when (i) it is not
contaminated with extraneous matter, such as the vapours [from
marshes or lakes, or from canals or open sewers : Aegineta ;
or the gaseous products from chemical works, etc. : modern]'
or smoke and soot.* (2) It is open to the sky [i.e. not shut in
by high mountains: Aegineta; and, generally, is able to circulate
freely round us : Nash]. (3) Is not confined in caves [cf.
Grotto del Cane], or between high walls, or shut up in houses (or
m underground cisterns).

275. Once a putrefactive process has begun in the air, it is
more likely to continue if the air is free and exposed than when
it is enclosed and concealed. Except for that, it is better that
air should be free and exposed.

276. Healthy air remains clear unless there be admixed
with it vapours from lakes or from stagnant and deep waters or

marshy lands, or from places where potherbs are cultivated

especially cabbages and herb rocket ; or where certain resinous
trees or trees of bad temperament (box, yew) grow, or where nuts
or figs grow, or where there are offensive odours and evil-smelling

* ° n <r may ai S o add: germ-laden dust, or particles of saliva and exhaled
particles of moisture charged with possibly pathogenic microbes. Note that ex-

of Ht^^T a ^ S °' 5 I" C ! nt - ° f ° rganic im P»riti^ which are much more a source
of disease than the carbon dioxide gas produced by respiration.

l86 THE CANON OF MEDICINE

winds. In short, the air remains clear if healthy winds, coming

from high or level ground, blow over the district.

Such air is not retained deep in the earth. It becomes
warm quickly after sunrise, and becomes cold quickly after the
sun has set. The air found confined within the walls of recently
built houses, is not likely to be healthy, as the air is not quite dry
owins to the lime in the walls.

Air is good when it does not interfere with one s breathing
or cause the throat to contract. . .

277 You have already learnt that changes occur in the air
which are (i) in accord with its nature, (2) contrary to its nature
(preternatural), (3) neither the one nor the other. _

Of the changes in the atmosphere which are not in accord
with its nature, these are either contrary to or not contrary to it.
Sometimes the changes run in cycles, sometimes not ; they may
occur at certain seasons ; they may be periodic, and sometimes

n0t " It is more healthy if the seasons accord with the nature of
the atmosphere, for otherwise illnesses come about.

S 181 The effects of the different climates (hot, cold, damp,
drv) on the body, and the diseases associated with each are given by
various ancient writers, but the statements often *? *7™<* ™*
one another. It is sufficient to consider the possibility that, apart
Tom infective agents, the temperature and humidity of a region
afferts the nutrition of the body, the vigour of the body and is
accompanied by liability of certain organs to disease (gastric,

^^uS£tf thefts been studied in modern times in its
relation to liability to induce disease The average normal re ative
humiditv is 75 per cent. ; excess of moisture makes the air leei
chSy Mists are detrimental because they absorb the warming rays

° f ^Stagnant air produces " stuffiness," for instance in rooms. This,
is due to the air heated by the skin remaining close to the skin and
preventing the latter from cooling. The surface circulation fads to
receive its proper stimulus in consequence. 123 (p. 120.)

The following passage in the Su-wen is of interest : Huang
Ti asked in what dinner cold and heat, dryness and moisture, wind
and fire operated on man, and how they produced the transformation
of all things " Ctii Po replied : "... the Five Fluids come for-
ward in turn, and each of them takes precedence once. When they
lonot keep in their proper spheres there is disaster when they do,
everything is well ordered," etc. (Forke, 23 p. 250-252.)

THE CANON OF MEDICINE 187

6. The Influence of the Changes in the Quality of the
Atmosphere ; the Diseases incident to the Several Seasons
and Kinds of Weather

278. Hot atmosphere. A hot atmosphere disperses the
breath and has a relaxing effect. A moderate degree of heat
induces redness by drawing blood to the surface of the body.
A great degree of heat results in a yellow colour because it breaks
down (the components of) the blood which has been drawn to the
cutaneous vessels. It also evokes sweating, diminishes the
amount of urine, impairs the digestion and induces thirst.

Cold atmosphere. A cold atmosphere has a constricting
effect. It strengthens the digestion, and increases the amount
cf urine. The reason for the latter is that it causes the humours
to become imprisoned, so that only a small portion of them can
become resolved into sweat. Another reason is given presently.
Cold induces constipation because the anal muscles remain
tightly contracted and the rectum does not respond to the call of
the intestines ; hence the faeces linger long in the intestines
instead of descending (out of. the sigmoid), and their watery
constituent is re-absorbed and passes into the urine.

Moist atmosphere. This has a softening effect on the skin,
and renders the body moist as a whole.

Dry atmosphere. This has a drying effect on the skin, and
renders it rough and dusky.

279. Fogs. — Foggy air has a depressing effect on the mind,
and disturbs and confuses the humours. This kind of air is not
the same as " dense " air, for the latter is dense in substance,
whereas foggy air is so because the particles with which it is
mingled are coarse (nearly or actually visible). The sign of such
an air is that stars of small magnitude are scarcely seen through
it, and even the brilliance of the planets is reduced to the lumino-
sity of fixed stars. Murky air is produced (when it is very cold)
by the presence of much fuliginous vapour, and of smoke, or by
absence of good winds.

This will ^ suffice about this subject for the present ; we
shall return to it later in speaking of preternatural changes in the

air

280. The Seasons. Every season has its own proper
characteristics. The characters occurring at the end of one
season, and the diseases associated with this, agree with those
occurring at the beginning of the next season.

1 88 THE CANON OF MEDICINE

Changes' which Spring produces in the Body.

281. When the temperament of the spring conforms to
type, it is a very healthy season ; its temperament corresponds to
that of the breath and of the blood, although the fact of its being
in equipoise, as already explained, makes it tend towards the
tenuity and enervating character of hot air, and also towards
moisture. It renders the skin ruddy by drawing the blood to the
surface to a moderate degree, and yet it does not effect that degree
of dispersal of the breath which an over hot summer does.

At this season of the year, the humours of the body, hitherto
stagnant, bestir themselves and circulate. Chronic disorders are
therefore met with. In persons of atrabilious temperament the
atrabilious humour comes into activity. Persons who have over-
fed during the winter without taking much exercise, so that the
humours are redundant, are liable to spring-time diseases
because these immature humours now become active and dis-
seminated (through the tissues).

A spring which is prolonged without losing its attempered
character will be followed by few diseases in summer.

282. The diseases of spring. Nosebleeding, effusion of
blood, fermentation in the atrabilious humour or in the bilious
humour. Inflammatory deposits ; carbuncles ; anginas (which
may be of severe type); abscesses of various kinds. Varicose
veins may " burst," there may be haemoptysis, and a cough
becomes increasingly troublesome especially if the early part of
spring be winterly.. Those persons who have such disorders,
and most of all, phthisis, will be in a worse state.

[Bronchitis, Bronchopneumonia, Influenza. In early spring : Measles.]

In persons of a phlegmatic constitution, the season of spring
brings movement of the serous humour, and there is a tendency
to apoplexy, paralysis, and joint trouble. Such disorders are
more likely to arise if there be any vigorous corporeal or psychic
movement (emotion), or if calefacient articles of food are included
in the diet, for all these enhance the effect of the atmosphere at
this season.

The most efficient means of averting maladies incident
to spring : venesection ; purgation ; semi-starvation, or res-
triction of food, increasing the fluids (especially_ syrups), but
reducing the intoxicating liquors, and even then taking them only

diluted.

283. Relation to periods of life. Puberty and the time ot
life thereabout are benefited by spring-time.

THE CANON OF MEDICINE 189

Changes which Summer produces in the Body.

284. In summertime* : the humours are dispersed ; the
faculties and natural functions are impaired owing to the exces-
sive dispersion. The bloodf and serous humour are diminished
in amount ; the bilious humour increases in amount ; and
towards the end of the summer, the atrabilious humour increases
in amount as a result of the dispersion of the attenuated matters,
whereby the heavier particles stay behind in increasing amount!
This is why old persons and those of similar nature feel stronger
in summer.

The colour of the body becomes citron-yellow as a result of
the dispersal of that which the summer heat draws out of the
(surface) blood.

285. Effect of Summer on the course of diseases. — In summer-
cime diseases show shorter stages. For, on the one hand, in
robust persons, the warm air helps to disperse and mature 'the
disease-matter, and also discharges it from the body. On the
other hand, in weakly persons, the atmospheric heat only
adds to their weakness by its relaxing influence. The sick
person will therefore lose his strength and die. Further-
more, if the summer be hot and dry, illnesses are quickly broken
up ; whereas if it be wet, the humours becomes glutinous in
character, the stages of the diseases are prolonged, and recovery
is delayed. In that case the disease comes to be of long duration.
For instance, a simple ulcer may become obstinate, may spread,
and may deepen. Dropsy and lienteric diarrhoea, and looseness
of the bowels are liable to occur. This is all because of the flow of
redundant humours downwards from the upper parts to the lower.

288. Diseases specially associated with the hot season. If
very hot : tertian, continued, and burning fevers ; emaciation - y
pains in the ears ; ophthalmia. If cupping be not done \
erysipelas is common ; also furunculosis/ (These are of like
nature to summer.) If spring-like : mild benign fevers, in
which the tongue and fauces do not become rough and harsh,
and there is no dryness of skin. This, is because the sweating
continues m plenty, especially at the crisis. For the heat and
moisture co-operate with it — and the former resolves the humours,
the latter softens the skin and opens the pores.
_ _ If southerly : deaths are frequent. Variola, morbilli, and
similar serious diseases are common.

August £ in Se'fembef ° Und ^^^ 1S hi S hest ^ to <* <*eg. F. at the end of
+ The blood is ** thin " in summer ; " thick " in autumn.

1 9 o THE CANOH OF MEDICINE

If northerly : this is favourable to health. If diseases
arise, they are diseases of " expression " ; that is, disease-matter
is caused to circulate by the action of the innate heat as well as by
the exterior heat ; then, being exposed to the cold atmosphere,
it is expressed from the body. This occurs in rheumatisms,
catarrhs, and their sequelae.

If northerly and also dry : this is beneficial for persons ot
phlegmatic constitution, and also for women. Persons of bilious
constitution are liable to develop eye-trouble, acute fevers of long
duration, and diseases due to the oxidation of an excess of bilious
humour (which has accumulated in such persons), and diseases
arising from a redundance of the atrabilious humour.

rSummer diarrhoea, and bowel diseases, and enteric]

f™ That the frequency of disease in hot weather is to be partly ascribed
to the § multiplication of flies under the favouring influence of the ground heat a^
warm air was of course not known in Avicenna s time On the other hand the
c?us™ of souring of milk in hot weather is still not understood, and the incidence of
some febrile conditions is parallel.

Changes which Autumn produces in the Body.
287 e The autumn season brings many diseases for these
reasons :* (i) there is exposure to a hot sun by day, and the
nights are cold. (2) The humours are vitiated by the following :
(i) abundance of fruits in the dietary, (ii) bad articles of diet,
(iii) dispersion of attenuated matter, leaving dense particles
behind and these then undergo oxidation, (iv) in summer the
fermenting humours pass to the skin and the natural faculties
can be brought to bear on them so as to disperse and expel
them • but in autumn, the cold atmosphere causes the humours
to be thrown back into the interior parts, where they accumulate
and are (as it were) imprisoned. (3) The vigour of the body
has been impaired by the preceding summer.

288, In autumn, the blood is much less in amount because
this season is contrary in temperament to the blood. Conse-
quently it cannot help blood to form, and that which the summer
has alreadv dispersed is not replaced. On the other hand, the
bilious humour becomes relatively increased during the summer,
and predominates during autumn. The atrabilious humour is
more abundant at the end of summer because of the oxidation _ or
the humours during summer, and this produces ash-like
residues, which tend to sediment under the influence of the

autumnal cold.

289. List of autumnal diseases and disorders. (1) Severs :
composite ; quartan— due to abundance of atrabilious humour
and the agent already described ; associated effects —enlarge-

THE CANON OF MEDICINE 191

ment of the spleen, oliguria (the urine only passes drop by drop
owing to the temperament ofthe blood being diverse — between
heat and coldness), dysuria (partly because the urine only comes
drop by drop), lienteria (because the cold drives the -rarefied
portions of the humours into the interior parts of the body) ;
simple hectic fever ; this is more severe during this season
because it is desiccant in character.

[Scarlet fever : diphtheria.]

(ii.) Diseases of the individual organs. — Skin : impetigo,
excoriating scabies ; " canker"; pustules (especially if the
autumn be dry and the preceding summer was hot).— '-Throat :
acute " choleric " angina.

(Cf. the corresponding disease in spring, in this case due to serous humour
the reason of the difference of humour in the two forms lies in the fact that the
season preceding in each case favoured the prevalence of that humour, and it is this
that constitutes the " soil " upon which the anginal infection thrives.)

Lung : Autumntide is harmful for persons suffering from
phthisis and chronic pulmonary affections. If a person had such
a disease latent in him at the onset of autumn, he would show the
signs of it at the end of the season. Brain : apoplexy ; mental
disease is common because the bilious humour is unhealthy and
atrabilious humours are admixed with it.

\_Intestinal tract : diarrhoea, etc.]

(lii.) Pains : in the joints ; sciatica ; pains in the back
and hips (due to the stagnation and subsequent imprisonment
of the_ insoluble parts of the humours which summer brought
into circulation).

Worms. — These multiply because digestion is deficient,
and there is lack of expulsive action.

290 . Autumn is, so to speak, the foster-mother for the
disorders left by the summer-time. Autumn is more healthy
if the weather be very damp and rainy, and is more unhealthy
if the weather be dry.

291. Relation to Periods of life. — The first part of autumn
is to some extent beneficial for old people, but the last part
is very injurious for them. (In the first place there is the cold,
in the second place there is the residue of the oxidation of
humours of summer-time).

Changes which Winter produces in the Body.

292. Winter is a help for digestion, because the cold
weather as it were embraces the innate heat and fosters it, and
makes it more concentrated and less prone to dispersion.

That is why fruits are scarce, and why people feel the need

4-t

4.4.

1-1

4-0

192 THE CANON OF MEDICINE

only of light aliments, and take little exercise after a good meal,
and gather together in warm places.

293. In winter there is much sediment in the urine, as
compared with the summer, and the amount passed is greater.
The bilious humour is lessened in winter because it is cold, and
the day is short and the nights long. The insoluble portions of
the humours are more confined. During the winter, therefore,
the diet should include more incisive and more attenuant aliments.

294. The disorders of wintertime. These are chiefly
phlegmatic in character. The serous humour is _ plentiful at
this period. Thus, it is very often present in vomited matter ;
inflammatory foci are usually of a whitish colour in winter-
time ; coryza is common, and begins when the autumnal air
is changing. Less common are : pleurisy, pulmonary ^inflam-
mations, hoarseness and sore throat. Less common still are :
pains in the chest, side, back and loins ; nervous disorders
(chronic headache); especially apoplexy; epileptic seizures).
In all these cases the serous humours are aggregated and con-
fined, besides being increased in amount.

295. Relation to Periods of Life. — Winter is inimical to
old persons and to those akin to them in nature.* Middle-
aged persons are likely to be in health in this season.

§ 1:83. The following curves showing the seasonal variations

in the character of the blood (red cell content ; haemoglobin) as
made out by modern investigations, are of interest in connection with
the above (280-295).

M Cells

1 1 1 * • \ 1 ; ! ' —

Jan. Fck. PU. Ap. My J u »i T.I, fl-j- Stf. Oil-. «>*. i«.

A. Curve showing the variations in red cell count in the same person through-
out the year. 1-12, the successive months of the year ; 3.9-4-8- number of million red
cells per c.mm.

B. Curve showing the variations in hasmoglobin content from month to month.
! — 12, as in A : 78 — 88, percentage of hasmoglobin. (From Lippincott, Journ.
Lab. Clin. Med., 1927, 679.)

* Note that in winter the ground temperature is lowest — 41 deg. F. at end of
February.

THE CANON OF MEDICINE 193

7. The Influences of Seasonal Sequences
(Seasonal Cycles)

296. When a northerly spring follows a southerly winter,
the summer will be very hot, and waters will accumulate, various,
matters being carried on from the spring into the summer.
Hence in the following autumn, there will be an increased
death-rate among adolescents ; and dysentery and intestinal
ulcers and tertian fever will be frequent.

297. If the winter was extremely rainy, those due to
give birth in the spring will be liable, to abort, but if they carry
to full time, the offspring will be weakly, or suffer from a fatal
or dangerous illness. Men are liable to eye diseases and
haemorrhages. Old persons are liable to catarrhs which pass
down into the interior organs ; indeed they may meet with
sudden death from a sudden obstruction to the flow of the breath'
through channels which have become overfull.

298. If the spring is rainy and southerly, following upon
a northerly winter, there will be many cases of acute fever in
the summer, and there will be eye affections, nose-bleeding,
looseness of the bowels. Most of these depend on the flow
of serous humour — imprisoned during the winter — passing
down into the interior organs and then caused to move on by
the heat. This is specially so in persons of moist tempera-
ment, like women. Sepsis and septic fevers are also common.

299. Should the summer become rainy at the time of
the rising of the dogstar, followed by northerly wind, there is
a prospect of good health and of the resolution of illnesses.
Such a season is worse for women and for juveniles, for if they
escape these illnesses, they run the risk of being afflicted with
quartan, because the humours become oxidised, and a sediment
or ash results, upon which dropsy, pains in the spleen, and weak-
ness of the liver supervene. Such risk is only slight in old per-
sons or in persons susceptible to cold.

300. If the autumn after a dry and northerly summer
is rainy and southerly, it disposes people to suffer from head-
ache, cough, sore throat,' and coryza in the winter.

If the autumn after a dry and southerly summer be rainy .
and northerly, there will be many cases of headache, rheumatism,
coughs, sore throat, in the winter.

If the autumn after a southerly summer be northerly,
the prevailing diseases are those of " expression " (see 286) '
and of congestion of humours, as already stated.

i 94 THE CANON OF MEDICINE

301 . If both autumn and summer were southerly and
wet, humours will multiply so that the diseases of expression
will appear in winter which we have enumerated (294), and it
will not be long before the disease-matter becomes coherent,
aggregated^ and imprisoned ; for not only are the humours
plentiful but there are no vapours to expedite them away from
the body. This produces a risk of septic diseases. The winter
will not fail to bring out many disorders because of this very
cohesion of the undue amount of morbific matter.

If both autumn and summer are dry and northerly, the
winter will be beneficial to a person for whom moisture is
injurious, and also to women. Such persons will, however,
be liable to dry eye-affections, prolonged catarrhs, acute fevers,
and mental disorders with depression.

302. A cold and rainy winter produces burning of the

urine.

303 . A very hot and dry summer produces the following
disorders in the following season : anginas (pernicious, and non-
malignant) ; anginas which produce a discharge (these may-
burst externally or internally), anginas which do not produce a
discharge ; variola ; morbilli (both these last two are favourable) ;
eye-affections ; mental depression ; difficult micturition ; reten-
tion of the menses ; retention of the expectoration ; haemoptysis.

304. If a .dry spring follows a dry winter, this is bad.
The trees and herbage are liable to decay and they are injurious
to the animals which feed on them ; and, in turn, to the human
beings which feed on them.

§ 1 84. A bnormal quality of the seasons. This idea is developed
in an interesting manner in the Chinese Classic "Li Ki " 47 (VI) as
showing the consequences in terms of weather (storms, floods,
droughts, hurricanes, etc.), and in regard to the prospects in the
crops (maturing too soon, maturing too late to yield any produce,
diseases of crops, or infections by various larvae, or insects), as well as
the possibility of pestilential outbreaks, or the prevalence of such
diseases as bronchitis, rheumatism, skin diseases, general ill-health
(debility). Flourishing of certain objectionable weeds among the
grain or cereals.

§ 185. Seasonal cycles have to do with the sequences of develop-
mentnoted among the very low forms of life in Nature, e.g., the growth
of various orders of fungus (saprophytic, parasitic, non-pathogenic,
sub-pathogenic, and pathogenic) in various types of soil, or landscape,
depends on the existence of cold, cold and wet, warmth, warmth and
wet, warmth and dryness, as they are traced through their various
cycles (basidium, with basiodiospores, mycelium with gametes, and
- secidiospores, uredospores and teleutospores). The cyclical changes

THE CANON OF MEDICINE 195

which result in the apparent transformation of one " specific "
micro-organism into another " specific " schizomycete require
investigation in the open field of Nature. Bacteriology may be said
to have been imprisoned in the doctrine of immutability of species,
which is only upheld within the limitations of artificial culture-media
and inoculation experiments in warm-blooded animals. Many of the
types so familiar in human bacteriology may be looked on as terminal
phases of cycles, capable of being maintained at the same rank for
almost indefinite periods. The remaining nine-tenths of the cycle are
unknown, from inability to cause the types to re-enter it artificially.

(f) incidental mutations
8. Climate

305. We now proceed to complete the discourse about
the other changes in the quality of the atmosphere, not preter-
natural and yet not natural. That is, changes dependent on the
celestial factors as well as on terrestrial ones.

306. Celestial factors. — The changes dependent on celes-
tial bodies, such as the stars, are thus :— if many luminous
stars rise in one region of the sky, and the sun approaches
towards that region, the people living directly or nearly directly
under the sun's rays are exposed to greater heat. But if the
rays are oblique, the heating effect is lessened. The effect
of a vertical position of the rays on the head is not nearly so
great, unless they continue vertical for some time, and are
direct. (Joannitius says : the rising and setting of the stars
alters the nature of the atmosphere because when the sun ap-
proaches them or they it, the air becomes hotter. Under
contrary conditions, the air becomes colder).

§ 186. Solar, planetary and stellar influences on man, and
their relation to disease.— The subject may be summarized as follows.
{A) Genuine influences. —(a) Solar. Modern observations (Abbe
Moreux), voiced by H. W. Newton (Quart. Journ. Royal Meteorolog.
Soc, 1928), show that the existence of planetary influences on
this earth is only ridiculed by the ignorant. The observation
of sun-spots shows that there is a relation to the character of the
weather in certain regions, a relation to the development of earth-
quakes, and also a relation to mental states. This authority
traces an eleven-year cycle of change both in the earth's magnetic
changes and in the sun-spot cycle. The sun-spots are described
as tornadoes of white hot gas, and affect both ultra-violet ray
activity and electric radiations. He also suggests that there may
be another cause concerned which controls both solar storms and
terrestrial magnetic storms.

i 9 6 THE CANON OF MEDICINE

(The relation may be made more tangible by suggesting that
after all there are actual flames of fire emerging from the sun and
extending in a tenuous and yet real form right across space into our
own atmosphere, with inevitable effects both in inorganic and
organized worlds. Hence to suggest a relation between sickness,
suicide, and crime and solar storms or even planetary disturbances-
is not new and cannot be lightly set aside). .

(b) Solar and lunar. Everyday experience shows that_ the
atmospheric conditions vary according to the time of day and night.
The bearing of this on health has therefore been seen from the
earliest times (Ayurveda, 1924, Aug. ; p. 53)- (c) Planetary rise
and setting, lunar phases, positions of stars and constellations
(Arcturus, Pleiades, etc.) are all data for the study of the progress oi
the seasons. Hence two kinds of cycles come to notice— the cycle
of climatic changes, with an apparent relation to health and disease,
both in cattle and in man ; (ii) the cycle of extra-terrestrial changes.
Naturally the observers of ancient times, who were so convinced ot the
unity of the visible universe, sought to reduce to rule certain coinci-
dences in these cycles. Even if their association is irregular or only
discernible from generation to generation the subject would invite
study. Even nowadays it is unsafe to decide that there is nothing at

all to study in it. .

^87 (B) Fictitious relations. — {a) Symbolical, permissible,

but superfluous, (i) Stars may be spoken of as " healthy ' or
" unhealthy," " propitious " or " unpropitious ' (Cantica, 1. 104 ;
Costaeus Annotations to Avicenna), as a convenient abbreviation tor
a more or less complex group of concomitant climatic conditions,
(ii) The names of planets, or constellations may be used to represent
certain types of mental constitution (Modern astrology) lhus,
combativeness (fiery temper), ambition and pride, love and desire,
melancholy, dreaminess, intelligence and wisdom. These are seven
types assigned to as many planets. Again, the term astral may
be claimed appropriate because common to the stars and the
" astral form " of man. The same idea occurs in Paracelsus
(Hermetic writings, ii. 291), where he speaks of the senses and
intelligence and wisdom of the offspring being its sidereal body,
and derived " from the stars." Such usage of names implies that
there is some specially " deep " learning being propounded which is
denied to the ordinary student, who has not been initiated into the
inner circle of some cult— hermetic, rosicrucian, theosophicai, and
the like The fact is, however, that the phenomena of the so-
called " astral plane " are those of the " sensitive life " of scholastic
psychology ; careful and thorough study of this will show that the
other obscurities are superfluous, (b) Fallacious.— Those who take
the symbology of (ii) to be literally correct are " of the erring people
(O 6 78) The poet voiced this error in his words : " A moon which
Wights you if you dare behold " (Night 34, annotated by Burton, m

*' 3I But in these days it is easier to fall into the error of supposing
that there is no relation whatever between this world and sun, moon,

THE CANON OF MEDICINE 197

and stars, than to mistake purely terrestrial relations for the trans-
cendent.

307. Terrestrial factors, {a) Latitude ; (b) Altitude. —
High or low ; {c) Mountainous regions ; (d) Maritime countries ;
(e) Exposure to winds ; . (J) Nature of soil.

{a) Influence of latitude on Climate. — If the country
in question be between the Tropic of Cancer and that of Capri-
corn, the summer will be hotter than in a country further from
the torrid zone. The countries within the equinoctial zone ap-
proach equipoise, for while the vertical incidence of the sun's
rays does not make much impression, the fact of this position
being maintained for several hours enhances their effect. The
heat is greater at the middle of the eighth hour (the evening)
than at noon. Consequently, when the sun is at the end of
Cancer, or in the beginning of Leo, it is hotter than it is at the
end of its course. When the sun passes from the tropic of
Cancer to a place of less declination, its heat is greater than when
it has not yet reached the tropic of Cancer but is at the same
declination. In the countries in the equinoctial zone, the sun
is only vertical for a few days, and beyond that becomes rapidly
oblique. For the declination increases much more rapidly
towards the two poles than it does in the tropics. Yet, in the
tropics, there is hardly any movement perceptible to the senses
during any three or four days, so long does the sun linger ;
and all that time the heat is continuous. Hence one may con-
sider that countries whose latitude approaches complete declina-
tion are hotter than all others, and next to these countries
lying within fifteen degrees on either side towards the two poles.
In the equinoctial line the heat is not so very excessive as it is
in those countries which, are within the tropic of Cancer, and
countries which are still further north are still colder.

This concludes what must be discussed in regard to the
latitudes of countries, supposing them to be alike in all other
respects.

(b) Influence of the altitude of a country ^ whether high or low. — ■
Lowlands are hotter, highlands are colder. The strata of air
nearer to the earth round here, where we live (Persia) are hotter
because the sun's rays are more powerful ; the rays are more
oblique on the highlands, which are therefore colder. This is
explained in the work on natural philosophy. Low-lying places
take up more heat, and are therefore hotter.

198 THE CANON OF MEDICINE

country. — The climate of mountainous countries from the point
of view of residence, is discussed in 325.

High mountains influence the climate in. two ways : (i)
they reduce the power of the solar rays on the country, and afford
protection from them ; (ii) they serve as a wind-screen. The
former holds good when the mountains are on the northerly
aspect of those countries which are in the north. As the sun
runs its course across such a northerly country its heat is re-
flected from the mountains, and so the country is warmed in
spite of its being in the north. The same applies when the
mountains are in the west, leaving, the country exposed on the
east. If the mountains are in the east, the heat which the
country receives is less than when they are in the west, because as
the sun rises, hour by hour passes before its direct rays reach the
country, and by the time they fall vertically upon it, the sun is
already about to wane, and the heating quality of its rays de-
clines (J>). When the mountains are on the west, however,
the rays are more vertical with every hour.

(ii) Windscreens. — A northerly cooling wind may be
screened from a country by a mountain-range, in which case a
southerly warming wind gains the advantage. If a country-
lies between two mountain peaks the force of the winds across it
will- be much greater than if it were entirely flat. For when
air enters a narrow channel it usually goes on blowing without
ever stopping, just as water and the like would. Natural
science furnishes the explanation of this.

Countries whose climate is rendered mild by mountains are
exposed to some winds, and protected from others. If exposed
on the east and north, they are protected on the west and south.
(d) The influence of the sea on maritime countries. The
atmosphere in such countries is always more humid. If the
sea is on the north side of the country, that will help to make
the country cool, for the prevailing north wind is cold in character,
having come over the face of the water. If the sea is on the
south side of the country, a heavy southerly climate prevails,
especially if a mountain range intervenes between the sea and
the country.

If the sea is on the east side, the climate will be more
humid than when it is on the west side, because the sun will not,
cease increasing the evaporation of water as it rises in the heavens,
whereas this would not be the case if the sea were on the west.
To sum up, proximity of the sea makes the climate of a
country damp, and if there are no mountains to prevent constant

THE CANON OF MEDICINE 199

winds, the air is less liable to undergo putrefactive change.
Were there no winds (because. of an intervening mountain-range)
the air would be liable to undergo putrescence (of the organic
matters suspended in it), and the humours of the inhabitants
would also tend to undergo putrescence.

Hence it is clear that it is better for the prevailing wind
to be northerly • it is next best if the wind is easterly ; then
westerly, and it is worst if the prevailing wind is southerly.

(e) The influence of winds, (i) On all countries in general.
In most countries a southerly wind is hot and moist. It is hot
because of the sun's rays, and it is moist because usually the sea
is to the south, and the strong heat of the sun on the equatorial
seas disseminates water vapours which become carried on by
the winds. This is why southerly winds are relaxing.

The northerly winds are usually cold because they have
traversed mountains and snow-clad territories ; they are also
dry because very little water-vapour is admixed. This is because
there is very little evaporation of water on the north, and there
are no seas intervening. On the contrary, they usually traverse
frozen waters and desert places.

Easterly winds are between cold and hot in character ;
they are drier than westerly winds, because there is less sea in
the north-east than in the north-west, and we live in the north.

Westerly winds are moist in quality because they traverse
seas and the sun, passing over the seas, 'warms them and evap-
orates the water ; but since the movements of the sun and the
winds are in contrary directions, the evaporation is not as great
as it is in the case of the easterly winds. Added to this is the
fact that easterly winds are strongest at the beginning of the day,
and the westerly winds blow strongest at the close of the day.
That is why the westerly winds are not as hot as the easterly,
and more inclined to be cold. The easterly winds are hotter,
and yet, comparing both east and west with the south and north
winds, they are temperate.

Sometimes the character of winds varies in a given territory
as a result of other factors. It is sometimes an advantage, in
some countries, for the south winds to be cooler, as happens when
there is a snowclad mountain range on the south ; these winds
are cooled in passing over the mountains. When a country
is enclosed in burning deserts, the northerly winds are hotter
than the south winds.

The simooms* are of two varieties: (i) those which have

* Simoom, " the poison wind," from Samn, poison, venom. (Burton, iv. 36.)

2oo THE CANON OF MEDICINE

traversed very hot deserts ; (ii) winds like a sort of smoke,
producing strange " terrifying " atmospheric effects simulating
flames of fire. They are heavy and sultry. A sort of kindling
and combustion occurs in them whereby the light part is separ-
ated and the heavy part (in which the burning fieriness remains)
sinks down to the lower strata. All these are powerful winds.
That is why wise philosophers believe them to arise in the upper
parts of the atmosphere, although the material basis is from
below.* But the movement, the blowing and whirling, begins
in the upper regions of the atmosphere. This is the usual
explanation, and its proof is to be. found in my book on natural

philosophy.

(it) The special climatic characters of the several countries.
This subject is deferred to a later chapter (318).

(/) The soil.-f Countries present varied characters accord-
ing to the dominant kind of soil The following varieties of soil
may be enumerated : clay, chalk, sandy (humus), rocky, or
stony, miry or slimy, muddy, evil-smelling. The characters
vary according to the mineral content.

Each kind of soil has its own effect both on the atmosphere
and on the water.

This statement contains an important truth. Certain spas and health-
resorts (Carlsbad, Bath, Droitwich, Baden, Bourbonne-les-Bams, Is ancy Wiesbaden)
owe their virtue not merely to the chemical composition of the water which is taken
by the patients, but also to the locality itself. The radiations which pass outwards
„at those parts of the earth produce a beneficent influence upon them as they walk
over the ground.

8 1 88 The soil mav be described as the breakdown products of
rocks or rock-formations of various kinds. Different kinds of soil
differ in the size of their particles : coarse sands show particles from
o 1-0.2 mm. in diameter; fine sands 0.5-0.05 mm.; silts have
particles varying from 0.04 to 0.004 mm. in diam. A sod composed
of the four groups (sand, clay, chalk, humus) is called " loam if
good for crops, and is then specified as clay loam, or sand loam,
according to the dominance of clay and sand respectively. _ It is the
size of the particles which determines the movements or circulation
of air and water through the soil. The amount of humus determines
the fertility in regard to micro-organisms, whether beneficial to
vegetation, or whether pathogenic to man. The presence of 4
per cent, of moisture in soil is the optimum for processes of decom-
position in it. Cold wet soils favour diphtheritic infection (Lane-

Notter). ^ r , ,,. , ^ .,

Gravel soil is sought after as favourable for dwellings ; but it

* The lower strata are near " earth," and the' highest strata of this world

^t 'ThfsoilmUbll described as elementary substance with which are intermingled
the decaying remains of animal and vegetable matter.

THE CANON OF MEDICINE 201

it be befouled by polluted waters, micro-organisms then flourish more
easily than in other soils, and it becomes more inimical to health.

§ 189. The inorganic elements in plants are really very finely powdered stones
(limestone, iron-stone, magnesium-stone, potash-stone, etc.), which have entered
into a condition of food-substance under the influence of light and heat, and life — ■
(Gilbert.)

(g) Misty districts and marshes. Joannitius refers to these,
saying that where there is decomposition in such regions,
-diseases and various plagues befall man.

§ 190. The factors on which the climate of a place depends, in
modern thought, are as follows: (1) the earth heat : the range in this
is 41-63 F. in England. When hot, the earth reflects ultra-violet
rays (2) the radiant energy of the sun. " Sun-power," which is
reflected from the sky and sea and earth. The rays are classified as
visible, ultra-violet (actinic or chemical), and infra-red. The ultra-
violet rays are arrested by smoke, mists, window-glass. (3) The
cooling power of the air. This depends on the rate of movement of
the air, as currents artificially induced, or wind ; the amount of
humidity ; the actual temperature of the air. Cold air tries the heart
and chest, more heat having to be produced ; hot air tries the diges-
tive organs and kidneys, because of the difficulty of getting rid of the
superfluous heat. (4) Altitude. The air is thin or rare at high
altitudes. (5) Ventilation of the dwelling-house.

To these must be added : prevalent winds ; proximity to sea ;
scenery ; nature of the ground — whether rocky (cold and dry),
fertile (hot and moist), muddy (cold and moist) ; whether porous or
impermeable ; water-holding or not ; actual chemical composition.

atmosphere

9. The Effect of Unfavourable Changes in the Air

which are Contrary to its Ordinary
Nature

IR (308) may be changed in (1) substance,
(2) qualities. — The substance may become
depraved apart from any increase or de-
crease in some of the intrinsic qualities.
Such an air is named " pestilential."* One
must remember that putrefactive processes
can occur in the atmosphere just as they
do in stagnant water.

* Though we now know that " pestilential " air is so because it is germ-laden,
that does not render this chapter " out of date." The general principles remain
the same. At the present day it is assumed that the air is always contaminated
from without — from the dust, e.g., on the ground that sunlight destroys germ-
life. However, facts speak otherwise in open Nature.

202 THE CANON OF MEDICINE

309. By the 'word " air " we do not mean the simple {impon-
derable) element, but the .atmosphere around us. Were the
atmosphere absolutely pure, the word " air " might be used
synonymously. But elemental substances cannot putresce ;
they can only change from one to another (as " water " which
changes to " air," e.g.), and they do this by a change either in
quality or in substance. The word " air " in this chapter, therefore,
as " atmosphere," is a composite substance, with spatial relations,
composed of true (elemental) air, watery vapour, terrene particles
(both of which form fogs and clouds, and smoke), and fiery
particles — all together. In the same zvay, when we speak of
" sea " as " water," " lakes " as " water," and so on, we do not
mean elemental water, but a composite substance, in which
" water," though predominant, is mixed with air, earth, and fire.

This carries the reader back to 19-25, and the comments thereon. The writ-
ings of the Chinese philosophers on the one hand, and of European alchemists on the
other may be interpreted accordingly, as Avicenna would have done. Examples
of " earth " : soil, metals, naked creatures ; " water " : spring water, ram water,
ditch-water, lake water ; the sea ; millet ; shellfish ; " fire " : wood, oil, stones,
lightning, the glow-worm, will-o'-the-wisp, trees, flowers, beans, feathered creatures.
Seemingly there is very little in common; Forke- 3 (p. 275, 276) discusses the
subject, at the same time referring to writings by Agrippa von Nettesheim.

310., The air so present in water may undergo putrescence,
with degradation of its substance, just as the stagnant water in
pools decomposes, with degradation of its substance.

311, Air generally becomes pestilential from putrefactive
changes towards the end of summer and during autumn. _ The
symptoms which such air produces in the human body will be
referred to later.

312, Change in primary qualities. Heat or cold may become
insupportable by destroying the crops and the fecundity oi
nature. This change may be in the same direction as the quality
of the season (for instance, the summer may become fiercely hot),
or it may be in the contrary direction (for instance, a spell of very
cold weather may arise during the summer season).

313, Effect on the human body. Changes in the character
of the atmosphere produce changes in the human body.
Putrescence of air induces septic changes in the body-fluids,
beginning with the pericardial fluid, because this is exposed to
it first. . .

Hot atmosphere. Great heat in the air renders the joints
flaccid and causes the humours to disperse. There is increase
of thirst, dispersion of the breath, failing vigour and digestion,
all because the innate heat is the instrument used by the vegetative

'"\^W — '

THE CANON OF MEDICINE 2 o 3

soul. A citron-yellow appears in the skin because the sanguineous
humour becomes dissipated and loses its red colour, while at
the same time the bilious humour increases in amount relatively
to the other humours. The heart becomes warmer (over and
above the innate heat), so that the humours flow and undergo
decomposition, and in that state they enter the interspaces of
the body and the weaker members. This is therefore not
beneficial to persons in health. The following diseases are
(however) benefited by this change : dropsy, palsy, cold catarrhs
tetanus, and certain (humid) spasmodic conditions. '

Cold atmosphere. This drives the innate heat into the
interior organs, unless the air has sufficient driving force itself
to penetrate them. This would be morbific. Cold atmosphere
does not interfere much with the circulation of the humours
or imprison them. But it favours catarrh, and is weakening to
the nerves. It has a very injurious effect on the trachea. If the
atmosphere is not so cold, it strengthens the digestion and all
the interior functions, and improves the appetite. On the one
hand it is more beneficial to a healthy person than a very hot
atmosphere, and on the other hand it is detrimental to nerve-
function. It closes the pores and causes matters within the bones
to pass outwards to the surface.

Moist atmosphere. A moist atmosphere benefits many tem-
peraments. It improves the colour and makes the skin clear
and soft. The pores remain open. However, it favours septic
processes. r

Dry atmosphere. A dry atmosphere has contrary effects.

A dry climate, with warm soil, where the sun power is good and
the cooling power is moderate (e.g. places with pine forests and
sheltered valleys) is beneficial for chest cases.— Dry uplands in
places where there are not periods of unsettled weather, and not near
the sea, are beneficial for rheumatic cases. 123

Choice of food according to climate. — For hot climates • no
meat ; use vegetable oils instead of animal fats. For cold climates-
meat, animal fats. For dry climates : fruits are needed. For wet
climates : sugar is needed. 123 (p. 1076).

Note that the weather affects animals as well as man. Cold hot
damp, dry weather, thunderstorms, affect domestic animals ^
(11. 307.)

10. The Influence of the Winds on the Body

In dealing with the changes in the atmosphere, we have
discussed the characters of the various winds. We now proceed
to deal with them from another point of view.

2o 4 THE CANON OF MEDICINE

314. The North Wind braces and hardens the body ; it
prevents the flow of visible excretions ; k closes the pores,
strengthens the digestion, causes constipation, increases the
urine, and makes septic pestilential atmosphere healthy. If
the south wind precedes the north, the south wind excites mucous
discharges, but the following north wind drives these fluids
inwardly. A discharge may appear externally. Hence a catarrh
[-al exudation] may become abundant, and chest troubles are

common.

Diseases liable to occur when the north wind prevails :
neuritic pains, pains in the side of the chest, in the joints, in the
bladder and uterus ; difficult micturition ; racking cough ;
shivering attacks.

315. The South Wind is relaxing for the strength ; it
opens the pores ; makes the humours agitated and confused,
so that they move from within outwards ; the senses become
heavy ; it induces sleepiness. It is one of the causes of breaking
down of ulcers, and makes them itch. It causes diseases to
relapse, and debilitates. It produces itching in podagra. It
excites migraine attacks. It causes fevers to become septic.
It does not, however, induce sore throat.

316. The East Wind. — If east winds prevail towards
. the end of the night, and in the early part of the day, they will
. have already been modified by the sun, being made more rarefied

and less humid. They are, therefore, drier and lighter in nature.
But if they occur at the close of the day, and at the beginning
of the night, the reverse is the case. On the whole, east winds
are more beneficial to health than are westerly ones.

317. The West Wind. — If west winds prevail at the end
of the night and in the early part of the day, the atmosphere will
not have received the heat of the sun, and is therefore denser
and more heavy. If they occur at the end of the day and at the
beginning of the night, the reverse holds good.

1 1. The Influence of Places of Residence on the Human

Body

In a previous section we have considered the characters
of certain inhabited regions. We now consider _ them from
another point of view, in more detail, without troubling to avoid
some repetitions.

318. Characters upon which the effect of habitable regions
on -people depends.

i. Whether high or low-lying.

THE CANON OF MEDICINE 205

2. Type of adjoining country (mountainous, maritime,
open or sheltered).

3. State of soil (clayey, muddy, mineral, damp, marshy).
_ 4. Whether the water is plentiful or scarce, stagnant or

flowing.

5. ■ Local factors (trees, mines, cemeteries, dead animals,
putrescent pools).

6. Purity or impurity of the atmosphere.

As we have also learnt, the temperament of the air is revealed
by the latitude of a territory, its elevation or lowness, proximity of
mountains and seas, the prevailing winds, the kind of soil..

In short, whenever the air becomes quickly cold after
sunset, and quickly warms after sunrise (we know it) is attenu-
ated. If the opposite is the case, the nature of the atmosphere
is the contrary.

The most harmful of all kinds of air is that which con-
tracts the heart and hinders inspiration, and makes breathing
difficult.

We now discuss each kind of locality in turn.

319. Hot countries. The hair becomes dark or black and
frizzly, and becomes gathered into tight clumps like pepper-
flowers ; the digestion is weakened. Old age comes on early,
owing to the great dissipation of breath, and the draining away
of the bodily moisture. This is seen in the land of the blacks
(Ethiopia, Abyssinia). Persons who reside in such countries :
become aged at thirty, are timid (as the breath is so much dis-
persed), and the body becomes soft and dark.

320. Cold countries. Persons who go to live in cold coun-
tries become robust and stronger, and bolder and more coura-
geous. The digestion improves. If the climate is also damp
the people will become obese and fleshy and coarse. The veins
will not show under the skin of the hands, and the joints are
indistinct in outline. The body becomes pale and delicate.

321. Damp wet countries. Here the summer is not very
warm, nor the winter very cold. People living in humid coun-
tries have beautiful faces with soft smooth complexions. They
soon get tired with exercise. They are liable to develop pro-
tracted fevers, with looseness of the bowels and menorrhage.
Piles, which are common, often bleed. Septic ulcers, fistulas, and
aphthous and pustular stomatitis are common ; also epilepsy.

322. Here the summer is very hot and the winter very
cold. People who live in dry climates develop a dry tempera-
ment. The skin becomes dry and dusky as a result of the great

2.o6 THE CANON OF MEDICINE

dryness and roughness of the atmosphere. The brain soon
becomes dry in temperament.

323. Residence in rocky and exposed places. The climate
in such places is very hot in summer, and very cold in winter.
The body becomes hardened and sturdy, very hairy, strong,
with large prominent joints. Dryness rules in such persons ;
they are very wide-awake, and resist bad habits, are pertinacious,
warlike, skilful in the arts, and are energetic in character.

324. Residence in high altitudes. People residing in high
altitudes are healthy, strong, and capable of much physical
work ; they are long-lived.

High, altitudes are beneficial for nerve cases, but unfavourable for heart cases.

325. Residence in mountains and snow-clad places. People
living in such places resemble those living in cold countries,
being of great stature, strong, fierce, and given to toil, for the
seasons vary much. These countries are windy, the winds being
good as long as the snow lasts, but unhealthy when it
melts, especially if there should be mountains to screen off the
winds. In this case, the place becomes hot and damp.

326. Residence in low-lying countries. The air is very damp ;
and in summer is sultry, without modification by winds. The
inhabitants are therefore unhealthy and debilitated, liable to be
depressed and gloomy in disposition. The climate is unfavour-
able to the functions of the liver. Water is plentiful, and not
cold, especially if it is stagnant, lagunal or marshy. The air is
then unhealthy, as you already know.

327. Residence in maritime regions. .The heat and cold
of these regions is modified by their moisture ; hence injury is
resisted, and the body is inreceptive for whatever would otherwise
invade it. As regards moisture and dryness, no doubt, such
regions tend to be damp. If the country faces the north and has
no protection against north winds (the sea being on that side,
and the country being low), the climate will be more temperate.
If it faces to the south, the climate will be hot and insalubrious
(morbific).

Maritime places are beneficial for nerve cases.

328. Residence in northerly countries. Persons who live \n
the north resemble in character those who live in cold countries
with cold seasons. Diseases of " expression " (288) and those
due to confinement of the humours in the interior parts are
liable to occur. Digestion is usually good. Such persons are
long-lived.

THE CANON OF MEDICINE 207

The repletion with, and the lack of dispersion of, the humours
predisposes to epistaxis and rupture of varicose veins. Ulcers
readily heal owing to the vigour of the body and the purity of
the blood ; the external conditions are also favourable to healing,
because there is nothing to relax or moisten (the tissues). The
fact that the innate heat is plentiful in such people prevents
epilepsy from occurring, but if fits should occur they will be
correspondingly severe, for it would have to be a very powerful
agent to bring on such fits at all in these regions.

The great degree of heat in the heart makes such persons
leonine (wolfish) in disposition.

Effect on the female sex. Menstruation is defective owing to
constriction of the channels and the absence of the stimulus to
menstrual flow and to relaxation of the channels. Some assert
that this makes the women sterile; that their wombs do not open.
But this is contrary to experience ; at any rate as regards the
Germans [Turks, Parthians — in other readings]. My opinion
is that the great amount of innate heat makes up for the absence
of the stimulus to flow and to dilate the channels. Abortion,
it is said, is rare amongst women in these climates, and this fact
further supports the opinion that their vitality is great. However,
parturition is not easy because the organs in question remain
hard and will not open easily. If abortion should occur, it must
be ascribed to the cold. The milk will be scanty and thick,
because the cold prevents the blood from flowing easily enough
to the breasts.

When the vitality is impaired, people in these regions
(especially parient women) are liable to develop puerperal
tetanus, and wasting diseases, because the difficult labour makes
them strain so much, and consequently risk tearing the veins
in the chest, and the nerve and muscle-fibres. The former
leads to pulmonary ulcers; and the latter to spasmodic affections.
Another effect of the excessive straining during parturition is
ventral hernia.

. As regards the age of puberty (in these countries) : hydro-
cele arises, but disappears as the persons grow older. Female
slaves are liable to develop ascites and hydro-uterus ; but these
also pass away as they grow old. Ophthalmia is rare, but is
severe when it does occur.

329 . Residence in southerly countries. The climatic features
in these cases are those of hot countries and climates. The pre-
vailing winds are not beneficial to health.

The waters are usually salty and sulphur-containing-.

20<:

THE CANON OF MEDICINE

Moist humours accumulate in the head in people living in these
regions, as that is an effect of the south ; they pass downwards
and render the intestines loose. The limbs are weak and
flabby ; the senses are dulled ; the appetite for food and drink
is enfeebled ; and the lack of heat and weakness of the stomach
accounts, for the fact that wine is readily intoxicant. Ulcers heal
and soften slowly. " .

Effect on the female sex : Menstruation is profuse and is
arrested with difficulty. Pregnancy is rare. Abortion is fre-
quent, simply because illness is so frequent.

Effect on the male sex : There is a liability to severe diar-
rhoea ; bleeding of piles ; humid ophthalmia. But these are
quickly recovered from. Persons over fifty years of age are
liable to paralysis, which follows on catarrhal conditions. At all
ages there is a tendency to asthma, spasmodic diseases (tetanic
spasm, epilepsy), because there is this tendency, for serous
humour to accumulate in the head.

Both sexes are liable to develop fever in which heat and cold
occur simultaneously. Prolonged fevers come on in the winter,
and are nocturnal. Acute fevers are rare because of the liability
to diarrhoea, so that the more attenuated part of the humours is
continuously dispersed.

330. Residence in easterly countries. When a district is
exposed to the east, and is sheltered (by trees) on the west, it is
healthy and the climate is good. This is because the_ sun is
high over it in the early part of the day, thus rendermgthe
atmosphere clear. The purified air passes on and gentle winds
blow over it in advance of the rising sun, their direction being
corresponding.

331. Residence in westerly countries. When a district is
exposed on the west, and is sheltered (by trees) on the east, it does
not receive the sun till late in the day, when the rays are already
oblique. Hence the air never becomes rarefied or dry, but re-
mains dense and humid. The prevailing winds are westerly and
nocturnal. The climate of such places is therefore as of damp
countries, and the residents have a moderately hot and heavy
temperament. The climate is heavy because the air is heavy.
Were it not for that, the climate would be spring-like in nature.

Such districts are not as healthy as easterly ones,_ and they
tend to become more unhealthy. Some say that this kind of
country is spring-like in its character, and very healthy com-
pared with other kinds of country. But to my thinking the
climate has very bad characters, and this is because the sun's rays

THE CANON OF MEDICINE 209

do not reach them- until they are no longer strong enough to
warm the atmosphere ; and then the sun sets at once, and a cold
night then suddenly sets in. As the air is of humid tempera-
ment in such countries, the inhabitants are liable to have husky
voices, especially in autumn ; for they are prone to catarrhs from
stagnation of the serous humour.

332. How to choose a place of residence, and what type of
house should be selected. The choice of a place of residence
depends on : (1) the soil (see 307f) ; (2) position — whether high
or low-lying (atmospheric pressure, see 307b) ; (3) whether
exposed or sheltered, bare or covered with trees or woodlands or
forests (forests harbour moisture and foster the decay of vegeta-
tion) ; (4) the water-supply — its quality, whether the water is
covered in (artificially) or exposed to the air, whether concealed
or deep, marshy, whether thick or limpid, whether flowing from
a height or running over stones ; whether salty or " crude '' ;.
(5) the prevailing winds — whether exposed to or sheltered from,
the sun ; whether salubrious or not ; fresh (cold) and bracing
or dry and sultry (having blown over wide tracts of land), or
moist ; whether cold and healthy ; (6) the neighbouring
country (maritime, marshy, presence of lakes ; mountainous, or
flat ; rich in minerals or not ; forests, jungles, etc.) ; (7) whether
the ground air is pure and healthy, impure and unhealthy,
making the natives prone to illness ; what sort of illnesses
prevail ; (8) whether the natives are robust, have a good ap-
petite and digestion, and are accustomed to food of good
quality ; (9) the construction of house : whether with large,
roomy or with narrow entrances ; good ventilation, wide
chimneys. Do the doors and windows face east and north ?
One must be specially careful to arrange to have the easterly
winds able to enter the house and see that the rays of the sun can
enter all day, because the sun's rays render the air pure.

One should be close to plenty of sweet running water, open
to the sky, frozen in winter, and warm in summer, as all this is.
favourable to health. Nearness to stagnant water and that, to-
which light has no access is unfavourable.

(10) Amount of light ; temperature (hot, warm, cold) ;.
rainfall — average humidity of the atmosphere (see 249).

§ I9 1 ■ Type of house. The importance of this is well-known, but not as often
practically attended to. Overcrowding of houses is well-known to be a source of con-
tinual illness and loss of working capacity, yet only very slowly remedied. It is not
sufficiently realized that the befouling of the air through lack of air-space between
the houses is as dangerous as close contact with the organic emanations from the
human body; Such emanations cling to walls, floors, furniture, fomites, and
foster the multiplication of infective organisms. The relation between mouldy
walls and phthisis was insisted by Nash 136 (p. 52).

2 io THE CANON OF MEDICINE

We have now discussed the atmosphere and the geo-
graphical influences sufficiently. We now proceed with the
corporeal factors.

(ii). Corporeal Causes unavoidable because
Physiological.

12. The Influence of Exercise and Repose.

8 IQ2 There are three kinds of Movement :— (i) Local ; successive and
continuous reception of new positions in space ; here belong exercise, gymnastics,
batmng ° ( 2 ) In quahty : alteration ; this consists in the reception of new qualities ;
(3) In Quantity (increase or diminution). A certain amount of matter is acquired
or lost. (Mercier" 2, 517).

333 . The effect of exercise on the human body varies
according to (i) its degree (strong, weak) , amount (little, much),
and according to (ii) the amount of rest taken, (in) the movement
of the humours associated.

334. All degrees of exercise (strong, weak, little, or
alternating with rest) agree in increasing the innate heat. It
makes little difference whether the exercise be vigorous or weak
and associated with much rest or not, for it makes the body very
hot and even if exercise should entail a loss of the innate heat it
does so only to a small amount. The dissipation of heat is only
gradual, whereas the amount of heat produced is greater than the
loss If there be much of both exercise and repose, the effect
is to cool the body, because the natural heat is now greatly
dispersed, and consequently the body becomes dry. It the
exercise entail the handling of certain material, that material
usually adds to the effect of the exercise, though often there is a
lessened effect. For instance, if the exercise be in the course
of performing the fuller's art, there would result an increase or
coldness and moisture. If the exercise be in the course of the
performance of the spelter's art, there would be more heat and

cLrvncss

335 Repose always has (a) a cooling effect, because (i) the
envigorating life-giving heat passes away, and (n) the innate heat
is confined. It has (b) a choking and moistening effect, because
of the lack of dispersal of waste matters.

13. Conditions Associated with Sleep and Vigilance.

336 The effect of sleep is very similar to that produced
by repose ; that of vigilance is very similar to that produced by
exercise. In each case we must consider certain properties.

337 Sleep (i) strengthens all natural junctions (digestion
of the food and the elaboration of the digestive products into

THE CANON OF MEDICINE

21 I

good blood), by aggregating the interior heat and by relaxing the
sensitive faculties. (These are in abeyance, in sleep). It does
so because it renders the channels of the (mind-) breath moist and
relaxed. (2) It makes the substance of the breath turbid, and
prevents the exit of the vital breath (so that the vital heat accumu-
lates in the interior parts). (3) Sleep removes all types of
lassitude (821) and - it restrains strong evacuations. If then
followed by appropriate exercise (gymnastics), the power of
running is increased unless (effete) matters accumulate which
only the skin can remove. (4) Sleep sometimes helps to expel
these effete matters, in that it imprisons the interior heat and
procures the dissemination of the nutrients throughout the
body, and the expulsion of the effete matters which are under
the skin, as well as of those which are deep in the interior parts
of the body. These innermost matters push on those which
are in front of them in successive waves, until they finally
reach the subcutaneous tissues and are thence discharged
from the skin. The same action is achieved by wakefulness
to a still greater degree, but in this case the effete matter is
removed by dissipation, whereas sleep removes it by inducing
sweating. (5) Sleep induces sweating. It does this by a
process of overcoming the effete matter, and not by a process of
continuous dispersal of attenuated matter. When a person
sweats heavily during sleep, without obvious cause, nutrients
accumulate in excess of the bodily requirements ; when sleep
encounters matter adapted for digestion and maturation, it turns
it into the nature of blood and warms it, and in consequence
innate heat is engendered, and travels through and warms the
whole body. (6) If there are hot bilious humours, and the
period of sleep is prolonged, the body grows warm by extraneous
heat. (7) If at the time of sleep the stomach is empty, the
sleep will exert a cooling effect, in that it disperses the heat. If at
the time of sleep there is a humour not amenable to the digestive
power, the sleep will exert a cooling effect because of that to
which this humour gives rise.

Factor associated during the time of
sleep.

Effect on body.

Profuse sweating.

Gastric contents digestible.

Hot bilious humour.
Empty stomach (fasting)
Indigestible humour.

Accumulation of nutrients.
Completion of digestion and blood-
formation : formation of innate heat.
Formation of extraneous heat.'
Cooled ; heat is dispersed.
Cooled ; expansion of heat.

212 THE CANON OF MEDICINE

8 193. Aetius adds: .

Among the good effects of sleep are : forgetfulness of mental sufferings, rectifi-
cation of the distracted powers of reason ; relaxation of contracted tissues

The best time for sleep is after a meal ; it should end when the food is digested
(shown by percussion over the stomach), after which the bowels should be emptied.

The best time for sleep during the 24 hours is the night, because the humidity
and drowsy stillness of night contribute to perfect digestion. The worst time is
the day-time, because in that case one does not sleep long enough to enable the di-
gestion of the food to be completed. The result is acidity, flatulence, gurgling
in the bowels.

338. The waking state acts in the contrary way in all these^
respects. If it occur to an excessive degree, the temperament of
the brain changes to a certain dryness, with weakening and con-
fusion of the reasoning power, oxidative changes in the humours
and acute illnesses resulting. An excessive degree of sleep, on
the other hand, exerts an opposite effect, for it dulls the powers of
the mind, induces heaviness of the head and a cold intempera-
ment. This is owing to the hindrance of resolution which such
sleep brings about.

339. The waking state (i) disperses the matter, and so
increases the appetite and sense of hunger ; (2) disperses the
digestive power, and so impairs digestion.

During the waking state the body becomes hot exteriorly, cold and dry
interiorly (Joannitius).

Insomnia (lit. tossing about in bed), a state between watch-
fulness and sleep, is bad for all the bodily states.

340 . Undue somnolence entails an imprisonment of the
innate heat, and makes the body become cold exteriorly. This
is why so many blankets are needed to keep the limbs warm
during sleep, which are not required in the waking state.

The indications furnished by somnolence, and its various,
aspects, and states, will be fully dealt with in subsequent volumes,.
Allah willing.

14. The Influence of Perturbations of Mind.

.341. Changing states of mind (nafs), and the associated
" motions " of the breath are either interior or exterior, sudden,
or gradual.

When there is coldness interiorly, it moves outwards with the
breath ; hence if the breath were suddenly dispersed, the cold-
ness becomes excessive, and both exterior and interior cooling
occur, which may be followed by syncope or even death.

When there is coldness exteriorly, and heat interiorly, the
coldness moves inwards with the breath.

342. Great confinement of the breath, with both exterior
and interior cooling, results in severe syncope and even death.

THE CANON OF MEDICINE

213

Movement of the breath.

Direction.

Associated emotion.

Sudden and forcible
•Gentle and gradual
Sudden and forcible.
Gentle and gradual.

Expansibn.
Contraction

Outward
Outward
Inward.
Inward.

Anger.

Delight and moderate joy.

Fear, terror.

Gloom (" contracted

heart ") mental de

pression.

343. Confinement and dispersal of breath only occur
suddenly ; _ languishing of breath only develops by degrees.
By " languishing " I mean a slowly progressive confinement or
coarctation of the breath. When I say "the nature declines,"*
I refer to a gentle, gradual, step by' step dispersal of the vitality.

344. If two motions of the mind occur simultaneously,
the breath may move in two directions (contraction within itself,
and enlarging) at once. This happens (1) when there is fear,
dread, and anxiety about the future. (2) when anger and gloom
occur simultaneously. The two opposite movements may pro-
duce a sense of shame, because there is first the confinement of
the breath in the interior parts, and after that the power of
reason returns, and resolution appears, allowing the contracted
breath to expand again, and bring heat to the surface. The skin
now becomes red.

345. Influence on the body of mental disturbances of a different
category. The state of the mind of the parents affects the body
of the offspring ; as for instance, phantasies. As a rule, it is
some natural object which impresses the body. For instance,
some image of a boy pictured by both parents at the time of
conception may be realised in the infant when born ; or the
infant's breath may have a " colour " very like the colour seen
(mentally) by the mother whilst the seminal fluid was flowing
into her at coitus, or by the father during the time of this flow.f
Many persons hate to believe such things, and suppose they
can understand the states of the body without having realised the
fundamental state. The physician who seeks wisdom does not
deny these and allied things.

* See footnote to 199 (ii).

f Superficially, the suggestion that conception is synchronous with coition
would seem an instance of mediaeval ignorance. Costaeus, in annotating on the
passage, accepts the opinion that a strong desire on the part of either parent to see
self or partner repeated and reproduced is capable of securing that the conception shall
yield a child in whom the desire is ultimately realized. Favourable patency of
the internal ducts (cervix, etc.), whether anatomically or emotionally, in association
with voluntary control of supposedly purely involuntary muscular tissue, are co-
operative factors whereby the above suggestion is not error but sometimes fact. The
law of jelal and jemal plays an important part which is ultimately, in due time,
manifested by the sex of the product of conception. Thus when the male is jelal

2i 4 THE CANON OF MEDICINE

346. Other, instances of the influence of the phantasy on
the bodily state : (a) a movement of the mind which is intent on
considering red things induces a corresponding state of readiness
for a movement of the sanguineous humour. [Exanthems may
be associated with such a movement of sanguineous humour
(Costaeus)]. (b) energetic character : eating acrid things :
hardening of the -teeth, (c) introspective character : dwelling
on aches and pains in the limbs : aches and pains in the limbs,
(d) timid character : fearing lest some imagined event should
happen : change of temperament corresponding. [Fear of
catching a certain complaint : actually developing the disease
(Costaeus)]. (e) hopeful disposition : rejoicing in the thought
of something one would like to realise : change of temperament
corresponding.

DIETETICS

K, The Influence of Food and Drink.

" Most illnesses, even those which lead the sufferer to the specialist, arise
solely from long-continued errors of diet and regimen."

347. Food and drink influence the body in regard to (a)
quality; {b) material composition ; {c) " substance " as a whole.

It is essential to define each of these three terms exactly.

(a) Influence in regard to quality. — Heating and cooling
food and drink respectively make the body hot in virtue of
their own heat ; cold in virtue of their own coldness ; and
yet these qualities do not become an integral part of the body.

(F) Influence in regard to material corn-position. — The food
and drink in this case change from their own nature, so as to
receive the " form " of one or other of the human members
(tissues) ; and the matter of which the food is composed receives
the " form " of the member, without losing its own dominant
primary quality right through the whole process of digestion

the product is female, and vice versa, — the jelal or jemal relating not only to physical
affection, but to "anguish of love " ; and the physiological cycles in the two organisms
have also to do with the chances of conception. The subject is dealt with more
particularly in the fourth Book, in a form which is only apparently obsolete.

The belief that maternal mental states affect the growing embryo, both
physically and psychically, is natural, though rejected by some physicians. It is
a valuable saying that " we can control the attributes and thoughts of the offspring
and give it a far more valuable inheritance thereby than by any material fortune.""
It applies as an admonition to both parents.

" The woman produces an offspring like that being upon whom her thoughts
dwell at the time of conceiving." — (Charaka-Samhita, ii. 704.)

By contemplating on beautiful scenes of nature, beautiful pictures, pious
persons, etc., the mother contributes to make her child beautiful and virtuous
and possessed of other desirable qualities (ib. 745)

The whole subject bears on the causation of deformities, or malconforma-
tions (496).

THE CANON OF MEDICINE 2 i$

to the end of assimilation. Thus, the temperament of lettuce is
colder than that of the human body, and yet lettuce becomes
blood, and is thus capable of being converted into tissue. The
temperament of garlic is hotter than that of the human body and
it also becomes blood.

_(7) Influence in regard to "substance" as a whole. The

specific " form."— This is an action according to what food
is in itself, as apart from its four primary qualities, and apart
from whether it becomes like the tissues or not, or apart from
whether the body becomes like to it or not. Matter does not
enter into action in virtue of its quality of action. But action
ensues in virtue of its matter when the matter is changed by a
transforming faculty in the body, from the substance it originally
possesses, and (i) first renews whatever has been used up in
the body, and so (2) increases the innate heat in the blood.
Then (3) the effect of the primary qualities which remain
in the food after that comes into play.

.348. Action occurs in virtue of the substance when the
" form " of its " species " — resulting from its temperament
(for the elementary components are intermingled, and one
single thing emerges therefrom) —is made ready for receiving
the species ; a certain " form " is now super-added over and
above the _ form possessed by the primary qualities. But this
" form " is neither (1) the primary qualities of the matter,
nor (2) the temperament proceeding from those primary qualities.
This " form " is that perfection which the pattern of the ailment
receives according to its capacity, and its capacity is the out-
come of its temperament. Example : the attractive faculty
of the magnet ; the nature inherent in the various species of
plants and animals (the nature emerging from the temperament).
Nor is this " form " (3) any of the simple temperaments by them-
selves, for it is_ not hotness, moistness, dryness, or coldness,
either alone or in combination. Really speaking, it is some-
thing comparable with colour, odour, or intellect, soul, or some
other " form " imperceptible by the senses.

349. The " form " which arises after the temperament
has formed may ^be perfected by passive action. In this case
the " form " = " passive property." But it may also exhibit
active perfection. In this case " form " = " active property "
(active principle). This active property may be exerted upon
a human being, or it may not.

350. Any property may produce an effect on the human
body which is either desirable (useful, harmonious) or undesir-

2i6 THE CANON OF MEDICINE

able (inharmonious). Such an effect is not entirely derived
from its temperament ; it is also derived from the specific
" form," over and above the temperament. Hence we speak of
such an effect as derived from the substance as a whole (that is,
the " specific form "), and not from any of the primary qualities
or from a temperamental' intermingling of the qualities, .bor
instance, the action of peony in annulling epileptic seizures is
desirable. The action of aconite in destroying human sub-
stance " is an instance of undesirable action.

* * *

351. Returning from our digression, then, when we say
that a substance which is eaten or is introduced hypoder-
micallv (e.g. by inunction) is "hot" or "cold," we mean
not only that it is so virtually (not actually), but that it is virtually
hotter or colder than are our bodies.

352 " Power" "potentiality" is a term with two kinds

of meaning, (a) It may be used in reference to the action of the

' innate heat of the body upon it. As soon as the potentiality

encounters the action of the innate heat it submits to that, and so

becomes act.

(b) The word potentiality may also be considered inreterence
to its utility or advantage to the body. Thus we say that
sulphur is hot in potentiality (" virtually hot ").

353. When we say that a thing is hot or cold, we may mean
that one of the four imponderables is dominant in its tempera-
ment ; and we do not refer to the effect which it has on our

bodies. ■,•■•. u a

354 We may say that a certain medicine has such ana
such a potentiality, thereby meaning its utility or otherwise to
the body. Thus,' a scribe who has stopped writing still has the
■potentiality for writing. So we say that aconite has a destruc-
tive potentiality. In the one case, there is no act till after the
body has become evidently changed. In the other, the action
occurs at once, from the mere presence of the agent {e.g. viper
poison), or some time later, after it has undergone some certain
change in quality (e.g. aconite). _ ,

* * *

355 e There are four orders of medicaments — whether eaten,
or taken °in the fluid state, or whether given by inunction.

i„ The first degree. The action of the quality ot a
medicament on the body is imperceptible to the senses. Thus,

THE CANON OF MEDICINE 217

a warming or cooling effect is not perceived by the senses unless
it is given repeatedly, or in larger dose.

2. . The second degree. A greater degree of action, without
perceptibly interfering with the functions of the body or changing
their natural course (excepting incidentally, or because given in
large doses).

3. The third degree. There is evident interference with
function, but not markedly enough to produce breakdown or
death of tissue.

4. The fourth degree. Destruction or death of tissue is
produced. This is the degree produced by poisons. A poison
is lethal in all respects (that is, in all parts of its " substance ").

§ 194- (Another classification would be (a) medicaments which produce
change without destruction of function or tissue, (6) those which actually destroy
function or tissue. In each case there are two degrees— one imperceptible to the
senses, the other plainly evident.— This is Galen's grouping. The grouping into
four degrees still survives in the classification of burns.) .

Substances which are definitely poisonous may be classified into four groups
as follows : ^

(i) Corrosives. These produce immediate and violent irritation. Ex •
mineral acids, alkalis, corrosive sublimate.

... T/ (-) {quants : (a) Metallic, such as lead, copper, arsenic, phosphorus ;
(b) Vegetable, such as drastic purgatives (aloes, colocynth, croton oil) ; (c) Animal
such as canthandes. This group produces effects which simulate natural disease
such as gastric and intestinal disease, peritonitis, abdominal catastrophe.

_ (3) Neurotics. Ex. : hydrocyanic acid and the cyanides, opium, strychnine
aconite, belladonna.

(4) Gaseous, (a) Irritant : halogens, ammonia ; (6) Anaesthetics ; (c) Coal-
gas, carbon monoxide, etc.

There is another group classifiable under 355, 1 and 2, exemplified by common
salt, whicn is injurious or even toxic in cases of kidney disease ( iai , p. 390) ; and by
those foods against which some persons have idiosyncrasies, or " protein sensitive-
ness (shell-fish, fruits, etc.).

356. Fate of medicaments taken into the body.

A.— They are changed by the body (passive change).
(1.) The body itself is not changed nor restored to health
(a) Medicament changed into the likeness of the body - pure nutriment

{b) Medicament changed, but not into the likeness

,.. , ^ of the bod y ------ attempered medicine.

(11.) The body itself is also changed (active action).
(a) Change in medicament produces change in body,
and interferes with or even arrests function.
(a) the change is into the likeness of the body - medicinal food.
(ft) not into the likeness of the bodv - - - pure medicine

(6) The change in the body continues till life is

destroyed ------ venomous medicine.

B.— Ihey are not changed at all by the body, but they
produce a (deleterious) change in the body (active
action on the body) - pure poison.

Ad. B. — In saying a medicament is " not changed by our
body " we do not mean that it does not induce a formation of
heat in the body by affecting the innate heat, for, as a matter of
fact, most poisons only act on the body in that way, thereby

2i8 THE CANON OF MEDICINE

producing warmth. We mean that its " form " is not changed,
and that in consequence its, power continues to influence the body
until the latter has destroyed the " form." For instance, if the
nature of the medicament be hot, its nature reinforces its pro-
perty of dispersing the breath. Examples : viper venom ;
aconite. Again, if the medicament be cold, its nature rein-
forces its property by congealing or enfeebling the breath.
Ex. : scorpion venom, hyoscyamus (or, hellebore).

Ad. A. La. — Anything that is nutritious will eventually
change the temperament of the body, and in a natural manner.
It warms the body because when it becomes blood that is the
natural effect ; and the body becomes warmer. Lettuce and
gourds warm in this way. So in saying " warm " we do not
mean " warm the ' form,' ". but " warm that which arises out of
its own intrinsic quality — the ' species ' remaining."

Ad. A. ii. a. — Medicaments which are foods are altered by
the body first in quality, and later in " substance." This change
in quality may be in respect of heat, so that the medicament
warms (e.g. garlic) ; or it may be in respect of cold, so that the
body becomes cold (e.g. lettuce). Afterwards, when the
digestion and conversion into good blood has been completed,
the medicament produces warmth to the same extent to which it
has added to the volume of the blood, thereby increasing the
" substance " of the innate heat. How could it do otherwise
than furnish heat when it has itself been made hot, and its cold-
ness thereby abstracted ?

But even after the medicament has been changed in sub-
stance there still remains some of its innate quality (some hot,
some cold). There is some of the coldness of the lettuce left in
the blood which has been made from the lettuce, and there is
some of the heat of the garlic left in the blood which the garlic
has given rise to. This holds good for a certain period of time.
357. Some nutrient medicines are medicinal in quality
rather than nutrient, and others are nutrient rather than medi-
cinal. Some of the latter are more like the " substance " of
blood in nature (e.g. wine, egg-yolk, meat-juice), and others are
less so (e.g. bread, meat) and others are entirely different to the
substance of the blood (medicinal foods).

Food changes the state of the body both in quality and
quantity. Changes in quality have been discussed.

358_ Changes in quantity are in two directions. Either the
nutriment increases in the body until there is an aversion to
food ; obstructions therefore arise, and putrescence results.

THE CANON OF MEDICINE

219

Or it diminishes in amount until the body wastes away, and the
tissues dry up.

An increase in amount of nutriment is always cooling in
effect unless decomposition supervenes in it, so giving rise to
warmth. This warmth, due to putrescent changes, is extran-
eous ; for such changes [in the superfluous nutriment] are the
means by which extraneous heat [as opposed to innate heat]
enters the body.

359. Classification of Food-Stuffs.

(This passage is arranged in tabular form).

Texture of
nutriment.

Nutritious
quality.

Name of Aliment.

Notes.

Attenuated
(i.e., produce

Rich.

Meat juice, wine.
Eggs (raw or lightly

cooked).
Pottage.

These are considered rich
in nutriment because
most of their substance
is utilized by the body.

attenuated
blood).

Poor.

Potherbs.
Juleb.

Fruits (matian, pome-
granates, and the like).

These are attempered in
substance and quality.

Dense
(i.e., thicken
the blood).

Rich.

Hard-boiled eggs ; veal.

Poor.

Cheese, salted meat,
egg-plant and the like.

These are considered poor
in nutriment because
only a small portion of
them becomes blood.

360,, Arranged according to Quality of Chyme.

1. Making good chyme : egg-yolk, wine ; meat-juice, are highly nutritious :

they are attenuated.

Lettuce, matian, and pomegranate are feebly nutritious. These
are attenuated.

Boiled eggs, year-old lamb are highly nutritious. These are dense
m texture.

2. Making bad chyme: newly-killed meat of sucklings, pheasant, partridge

lung ; these are highly nutritious, and attenuated.

Radish, mustard, and many other kitchen-herbs ; these are nutrit-
ious, and attenuated.

Veal, duck, horseflesh ; these are highly nutritious, and dense in
texture.

Salt meat is feebly nutritious and dense in texture.

It will be easy to find the foods which occupy an inter-
mediate position between the attenuated and densely textured
foods.

§ 195- _ The study of food should include the following aspects.

(1) Digestibility. This depends on the density or tenuity of

texture of the food-stuff, as well as on the materials with which it is

220 THE CANON OF MEDICINE

associated. Thus the more fat-content, or fat-addition (from foods
combined with it), the less digestible, because the less permeable.
Again, digestibility may : be completely removed by so simple a
procedure as taking certain liquids (among -them, pure water) at
an unsuitable time after digestion has begun, or liquids which are
incompatible with certain foods before digestion, or in a state of
partial digestion. Avicenna's conception of the gastric contents as a
"broth" or "emulsion" is legitimate, and if these contents are
" torn off" the mucosa by foods or fluids taken after the digestion
of the meal has got under way, the whole process may stop beyond
power of renewal. The same holds good for the process in the small
intestine. This idea, ruling in the Canon, can be verified by anyone
in his daily experience. — Palatability has to do with digestibility.

(2) Assimilability. This depends on the kind of chyme which
will result.

(3) Ntitritive value. This, according to the Canon, will depend
on the kind of " humour " which the food yields ; how much residue
it leaves (therefore, whether constipating or relaxing). Thus we
have the classification of foods, according as they (1) enrich the blood :
cereals ; dairy produce, such as soft boiled eggs, milk ; fieshmeat ;
fowl ; certain vegetables. (2) Enrich the serous humour : mutton,
pork, one-year lamb, the potherbs atriplex and purslane. (3) In-
crease the amount of bile made, or excite a flow of bile : chicken,
fish with few scales and agile in habits, the potherbs garlic, mustard,
nasturtium. (4) Increase the amount of atrabilious humour :
goatflesh, newly-killed meat, cabbage, lentils. In each class there
would be subdivision's according to the digestibility— whether
digestible within two hours, or four hours, or later.

(4) Physiological value. This is a more general aspect,_in that
the other aspects contribute to its assessment. The old division of
foods into proteins, carbohydrates, fats, salts, water is not necessarily
to be rejected in favour of the modern division of foods according to
energy-values, heat values, and " accessory factors." Chemical
analysis of foods suffers from the fallacy that the substances so found
do not exist as such in the food — a statement based on the same
principle as will be discussed more carefully under the subject of
" drugs." Moreover, were these substances present as such, they
certainly do not circulate in the body, or function in the tissue cells
in the chemical form found under artificial conditions. Physiological
values may be assessed according to whether an ash is left in the
tissues after oxidation or not. Thus, body-building foods leave
an ash, heat generating foods do not. The important matter is the
formation of ash, because of the risk of this lingering in the body, or
even becoming firmly imprisoned in its tissues. Foods may also be
studied in regard to their depurative properties, according to their
alkalinity or aciditv, etc. See also 768, 773, 795, and §§ 248-252.

Thus there are other considerations than the popular ones of
work-production, and the practical objects which rule properly only
in the management of domestic animals.

i6.

THE CANON OF MEDICINE 221

The Various Kinds of Drinking Water.

ri~ J, '4 i

\k - J %1

.=> ":■■ -i
* ■, : r , \

' 2. ~ * ' V:
- ' ■ C- .".I

-"" .-. < ; !

','■1
.-;. ;- '._1i

■/. Sr-yj-

iNote the very great importance which the Moors attached to proper water-
supply. Having been accustomed to the life of the desert, they appreciated the value
of water better than any other peoples.

361. Water is the only one of the elements which has the
special property of entering into the composition of food and
drink — not that it is itself nutriment (although it will by itself
prolong life for some time), but rather that it enables the aliment
to penetrate into the human body and permeate and purify its
substance.

We do not wish to imply that water does not nourish at all,
but we mean that it is not, as nutriment is, potential blood giving
rise ultimately to tissue-substance. As an elementary sub-
stance, it is not changed in state in such a way as to become able
to receive the " form " of blood or of tissue. This can only
occur with a true compound.

362, _ Water is really a " substance " which helps to make
aliment fluid and attenuated, so that it can flow easily into the
blood-vessels and out of the excretory channels. Nutrition
cannot be effected without ic ; it is the handmaid of nutrition.

There is much to be said as to the part played by water in the
economy. Though apparently simple, its chemical structure is

2 22 THE CANON OF MEDICINE

complex. It is a -mixture of units of varying molecular complexity,
each unit being called a " hydrone." The number of molecules of
hydrone and polyhydrones ; constantly vanes, even at steady tempera-
tures, so that equilibrium regarding them is easily disturbed The
foreign matter always present in the water of Nature is essential to
life, assimilation being only possible in virtue of such constituents.
Apart from this, water is essential to metabolism— absorption,
digestion (enzyme action depends on it), osmosis, temperature
regulation, the maintenance of the salt concentration of the blood
at a constant level. The necessary reservoir of water in the tissues
is furnished by the muscular tissues, and their depletion has
serious consequences (502, § 274-279.), and their repletion entails
important interference with the physiological functions. It may be
noted however, that the idea that plentiful consumption of water
" flushes " organisms out of the body is not reliable. (Hemmeter,
Med. Rec, May 22, 1920.)

363 The various kinds of water differ (1) not merely in
the substance of aquosity, ■ but (2) in admixed matters, (3) their
own individual dominant primary qualities. .111

364 The best water is that from springs, provided they
arise in places uncontaminated by extraneous qualities. _ Waters
from rocky places are only good if they are not admixed with
earthy matters of putrescible nature which might cause the
water to putresce. Spring water from thx open ground is
healthier than water from a rocky place, provided it is flowing.
But not all flowing water is good ; it must be also exposed to the
sun and winds. Water acquires nobility from the region

whence it flows. ,

365 Stagnant water is not as bad in quality when exposed
to the air'as when it is deep underground. Yet running water is
not necessarily exposed to the air ; it is only so when it breaks
out from underground and flows out over the soil. Note, too
that water running over soil is more wholesome than that which
runs over stones, because the soil cleanses it by filtering off the
admixed extraneous matters in a way which stones do not .but
the soil must be open to the sky ; it must not be fetid or boggy
or nitrous, or the like, for should a large volume of water flow
rapidly over such soil, the admixed matters would pass into its
own nature. If the direction of the flow were eastwards, and
in summer, it would then be reputed as better m quality, especi-
ally the further away from its source it is collected. Such water
readily becomes warm or cold in the body. The next best water
is that which runs northwards. Such water passes slowly
through the stomach and is indigestible, and becomes warm or
cold in the body only slowly. Water which runs westwards or

THE CANON OF MEDICINE 223

southwards is bad, especially if the winds are southerly at the
time. ; .

366. Water which comes from high regions and has other
good qualities is more healthy. It is sweet, as it were.. It will
not bear being mixed with wine except in- small amount, and
unless the wine is light. It quickly becomes cold and quickly
warm because its " substance " is attenuated. That is why it is
cold in winter and warm in summer. It is tasteless and has no
odour. It passes out rapidly as urine, because whatever there
is in it which requires digestion is rapidly digested and dispersed.

367. You must note that the quickest way of assessing the
quality of a water is by its weight. Light water is healthier in all
respects. The weight may be ascertained by measure or by
means of the following procedure. Soak a linen cloth of like
weight in each of two waters to be tested. Dry thoroughly.
Weigh. The water belonging to the cloth which is lighter "is
the more satisfactory.

The characters of pure water, therefore, are: (i) Aspect: limpid, 32 clear,
pellucid, " diaphana." 83 (2) Taste: tasteless, or "sweet," 32 pleasant to drink,
and refreshing. (3) Odour : none. (4) Touch : soft, or gentle 32 ; cool. 33 (5) Other
properties : weight (367) ; vegetables boil quickly in it ; the place from which it
is obtained is neither too hot nor too cold ; " fertilizing " and " calm " (Honen 32 ,
P- 6 33) ; passes out of the body quickly (366).

368. Purification of water. Bad water may be purified by
sublimation and distillation. If that is not feasible, boiling will
suffice, for boiled water, as the learned know, is less likely to
cause inflammation and passes more rapidly through the body.
Ignorant persons believe that when water is boiled the attenuated
part is dispersed, and that therefore it is made denser ; hence
they think it is better not to boil water. But as you know, the
very nature of " water " means that its particles are alike in
attenuation and density. It is pure, simple [in the scholastic
sense], and will not thicken by boiling except in virtue of a cold
quality being dominant in it, and of earthy particles beino-
plentiful in it, which, although extremely minute, are not easily
separated out or precipitated. They are not plentiful enough
to break the continuity of the water and are too small to separate
out by standing. Hence they are bound to remain admixed
with the substance of the water. Boiling removes the density
which the quality of coldness produced ; the particles of water
are then forcibly rarefied and the substance of the water becomes
more and more rare, until the heavy earthy particles hitherto
suspended burst loose and fall down and sink to the bottom.
A nearly quite pure water remains behind.

22 4 THE CANON OF MEDICINE

369. That which has been separated by the distillation is
like (or very nearly like) in texture to that which remains behind,
for the particles of the water which has been distilled off are of the
same tenuity as the particles of that which remains. The
process of boiling does not attenuate or rarefy water directly ;
it does so only because it allows the cold quality to aggregate,
after which the admixed matter settles out. The proof of this is
that if a thick water be left to stand for a long time, hardly
anything settles out of it, but as soon as one boils it there is an
abundant precipitate and the water becomes light and clear,
because the boiling has made it rarefied. So, too, have you not
noticed that the waters of such a big river as the Jihon * especially
if collected a long way from its source, are very muddy at the
time but in a short time suddenly clarify by sedimentation, and
if you pour off the clear water and leave that standing, practically

nothing settles out of it ? .... „,

370 Some people praise Nile water very highly. I hey

enumerate four virtues in it : (i) the length of time which has

elapsed since it left its source ; (2) the good character of the soil

of the countries through which it travels ; (3) the fact that it runs

from due south to due north, so-that a continual rarefaction of its

waters is taking place ; (4) the incredibly enormous volume of

the water pouring into it.

371. If one should pour bad water every day from one
vessel to another, one would see as much deposit on the last day
as on the first. There is so little deposit during a day that it
never clarifies properly. The reason is that the admixed earthy
particles easily separate out from rarefied matter, for that is free
of heaviness, viscosity or oiliness, but not so easily from dense
matter. Boiling increases the rarefaction and so do the shaking-
movements incident to ebullition.

Commendable Waters.

372 Rain water is the best of waters, especially when it
falls during summer or during a thunderstorm. [Others say the

* The river Jihon, or Oxus (modern Amu Darya), is one of the great rivers of
Central Asia It runs through the country of Khorasan, between Samarcand and
thfcounlry called Bactria, as stated in the Glossary to the Venice edition of the
Canon Arising in the enormous glaciers of the mountamous_ ranges between East
Skestan and Afghanistan, and receiving important tributaries from the northern
slopes of the Hindu Kush, it emerges into open country being here bounded by
Bokhara on the north. It'varies frSm 1.000 yards to a mile in width in t^s region
and the stream flows from 7.\ to 5 miles an hour. It empties into the Sea of Aral
So ereat a ri£r would naturally be prized by the Persians, who regarded it as the
eaull of the NUe The fact that the great trade route of Central Asia from Khorasan
to China ioined this river in the above-mentioned region made it well-known to
Avicer a , 3 Zugh virtullly unknown to Europe until 2 oo years later, when Marco
Polo and his companions entered this country.

THE CANON OF MEDICINE 22 $

rain which falls in the spring, and that which falls during winter
are best,_ then that which falls during the fruit season, whereas
that which falls in summer is worst.] Rain falling during
stormy weather is very polluted and impure in nature, for at this
time the violent winds agitate those clouds whence the rain comes.
373. . Rainwater readily undergoes putrescence in spite of
being called laudable: This is because if is so rarefied that cor-
ruptible terrene matter and air quickly act upon it and set up
decomposition in it; the humours of the body therefore undergo
putrescence, and obstructions arise in the chest and the voice
becomes husky.

374. Some say that the reason for the putrescence is
that rain water is formed from the vapours which evaporate off
from various kinds of moisture. But were this the case, rain
water would not be laudable but uncommendable, and that is not
so. The real reason is that the substance of rain water is very
rarefied and tenuous, and when a substance is tenuous it has
more receptivity (and is therefore liable to putrescence). But if
boiled promptly, this risk of putrescence is lessened. (Aegineta
adds : rain water is very light, sweet and limpid ; it is tenuous
because it has been drawn up by the heat of the sun, and there-
fore only the lightest particles of sea-water, lake-water enter into
it). Rain water is soft to the touch.

375. Well tvater and water conveyed along aqueducts.
These are of bad quality as compared with spring water, because
they are confined and have been exposed to earthy matter for a
long time, and consequently cannot help being to some extent
putrescent. For in the process of being drawn, they are shaken
up by the power entailed (that is, by the mechanical contrivances
used) or by the influence of gravity rendered possible by the
slope of the channel. Of such waters those which are conveyed
by leaden pipes are more harmful, because they acquire certain
properties from the lead, and this makes them liable to bring on
a form of dysentery.

376. Snow water and water from melted ice. These are
coarse m texture. When pure and free from admixture with
deleterious substances, such water is good and healthy ; it is also
useful for cooling water, either by placing such water in it, or by
adding it to the water. There is little difference in the visible
character of these two kinds of water ; but they are denser in
texture than other kinds of water [because the finest particles are
squeezed out by the freezing (Aegineta)]. This kind of water
is harmful for persons suffering from neuritis. Boiling renders

226 THE CANON OF MEDICINE

such water wholesome. If ice water be made of bad water or if
the snow has attracted some bad property from the places upon
which it has fallen, it would be better to use. water free of such
injurious admixture.

River water was preferred before others by Rhazes ; Aetius preferred Nile
water to all others (see 370).

Spring water : the qualities vary according to whether the water comes from
north, south, east or west (Hippocrates) .

Non-Commendable Waters.

377. Marshy water : This is of worse quality than well
water because it stays a long time putrefying in the channels of
the decomposing earth, and diffuses out and moves up very
slowly, and then not by its own power, for it is so rich in (alluvial)
matter. Moreover, it only occurs in decomposing decaying
earth. Well-water on the other hand is cleansed by contact
with that which separates out from it and by the gases which
bubble up out of it, thereby keeping it in constant (molecular)
movement. Well-water does not remain in a confined state long
and does not linger in the channels and openings of the earth.

. 378. Stagnant water : Water in reedy marshes. This is
unhealthy and heavy, especially if in exposed situations, for these
do not become cold in winter unless and only in so ^ far as snow
happens to fall on them. They therefore give rise, in the body,
to serous humour. In summer, the sun makes them hot and so
they putresce and then they will give rise, in the body, to bilious
humour. There are three reasons why they cause disease :
(i) their inspissated character ; (2) admixture with earthy
matter ; (3) dispersion of their subtile particles.

379. The following are the diseases liable to develop after
drinking such water : (a) diseases of the spleen. These result
in heaping up of the viscera and stretching of the peritoneum — ■
the belly being hard and tense ; wasting of the arms, legs and
neck — for the nutrition fails because of the state of the spleen
despite the excessive appetite and thirst ; constipation ; vomit-
ing is difficult to induce, (b) dropsy : from retention of the
water, (c) inflammatory deposits in the lung and spleen, (d)
"dysenteric ailments, with the result that the hands and feet
become dry, and the liver becomes enfeebled and nutrition is
impaired, ' (e) quartan fevers (in summer), (f) piles, varices,
lax swellings of inflammatory nature, insanity (especially in
winter).

380. The effect of such water on women. Conception and
parturition are both difficult. The offspring will be male and

THE CANON OF MEDICINE 227

will be liable to develop inflammatory masses and then waste
away. — Moles are liable to occur because impregnation is often
faulty ; the offspring is found to" have rupture. — Varicose veins
and ulcers of the leg ; these heal with difficulty. The appetite
increases and there is constipation leading to intestinalulceration.
Quartans are common.

381. Effect on old persons. " Ardent " fevers occur, as
accords with the dryness of their nature, and of the stomach.

382. All stagnant waters, from whatever source, are
injurious to the stomach.

383. Channel water. This is very like stagnant water, but
is healthier because it does not linger so long in one spot. If it
is not actually flowing, this was because of some heaviness in it.
In many of these waters (i.e. including water in aqueducts, water
in irrigation channels) there is a certain stypticity, and they
quickly warm the interior organs. Hence they are not utilisable
in cases of fever or for persons in whom the bilious humour is
predominant. They are more applicable for cases of disease
where the treatment is to foster retention and maturation,

384. Waters containing metallic, substances. These are
injurious, though in some cases there is a certain value in them.
Thus, ferruginous waters impart strength to the internal organs,
prevent stomach trouble, and stimulate the appetite. They
resolve the spleen and are beneficial for those who cannot cohabit
properly.

Waters containing salts of ammonia are aperient, and
carminative. They may be either swallowed as a drink or given
as an enema, or used in a sitz-bath.

Waters containing alum suppress excessive menstruation
and haemoptysis and the bleeding of piles. But they render
persons who are liable to take fevers still more liable to develop
them.

385. Waters in which leeches live. These are injurious.

386. Salt water. This makes the body dry up and
become wasted. Its abstersive power makes it first laxative,
and afterwards constipating — because dry in nature. It
decomposes the blood and so gives rise to pruritus and
" scabies."

387. Acetous water, added to rain water which has to be
consumed arrests putrefactive changes in the water and provides
immunity from such ill-effects.

388. Milky water gives rise to calculus and obstructions.
Hence one should make use of diuretics after it. In fact, one

228 THE CANON OF MEDICINE

should take diuretics after drinking any coarse and heavy waters,
because they linger in the bowel. Fatty and sweet things (e.g.
theriacs) are also correctives for such water. The fact that
milky water brings on constipation makes it of value for some

persons.

389. Cold water. — Water which is only moderately cold
is more healthy than all others, because it stimulates the appetite
and strengthens the stomach. Nevertheless it weakens the
nerves and is harmful for cases of inflammatory disease in the
interior organs.

[Very cold water should be taken after food and then only
in small quantity (Aegineta).]

390. Tepid water incites nausea.

Warm water (that is, water which is a little warmer than tepid
water), taken on an empty stomach, is cleansing both to stomach
and intestines. But it has a weakening effect on the stomach if

taken often.

Hot water is beneficial for the following conditions :

(a) Head : " cold " headache ; inflammation of the eye ;
parotitis, quinsies; " dry " gums ; postauricular inflammations.
Mental conditions — epilepsy and " melancholia."

(b) Chest : asthma, solutions of continuity in the thorax ;
ulcers of the diaphragm.

(d) Female ailments : it evokes menstruation.

Hot water interferes with digestion and makes the food
swim about in the stomach. It does not quench thirst. It may
lead to dropsy, and hectic fever, and emaciation.

Very hot water is of great, value in colic ; it also disperses

flatulence.

391. Aerated waters : these are useful for certain in-

temperaments.

When various kinds of water, good and bad, are com-
mingled, their effect varies according to which proves dominant.

392. Correction of impure water : The correction of impure
water is specially referred to under " regimen for travellers " —
see 891.

Note also the following, from Aegineta: (i) add decoction of chick-peas;
(2) boil wild carrots with some small fish and fennel ; (3) beet, gourds, salts and
diluted wine. Marshy, saltish and bituminous water should be strained, -betid
smelling waters should be boiled or mixed with wine. _

When good and bad waters are mingled, the stronger dominates.

Other matters relative to water and its properties and

THE CANON OF MEDICINE 229

modes of action will be discussed in the- chapter on " Water as
one of the simples " in Book II — Allah permitting.

17. The Results of Retention and Evacuation.*
393. The following are the causes of retention of waste
matters : (1) weak expulsive faculty, (2) unduly strong retentive
faculty : the latter occurs in (a) weakness of digestive power, so
that aliments remain too long in the stomach, the natural reten-
tive faculty holding them back till they are sufficiently digested,
(b) narrowness and (V) obstruction of the channels, (d) coarseness
or viscidity of the waste matters. The former holds in the case
of (a) superabundance of the waste matters, so that the expulsive
faculty cannot deal with them, (b) insufficient informing sense for
defecation, this act being aided by voluntary effort. The result
may be that the effete matter is (compensatorily) removed to
other parts of the body by the action of the vegetative faculties.
Thus jaundice follows [gall-stone] colic ; the colic depends on
the retention, the jaundice is the compensatory evacuation.
Again, at the crisis of a fever, there may be retention of urine
and faeces, and a critical evacuation occurs elsewhere.

394. Diseases consequent upon retention of waste matters. — ■
(i) Compositional : constipation, diarrhoea or laxity of the
bowels, spasmus humidus and the like ; inflammatory processes ;
furuncles, (ii) Intemperaments : septic conditions ; imprison-
ment of the innate heat, or mutation of this into igneity. There
may be so marked a coarctation that the innate heat is extin-
guished altogether, and coldness of the body supervenes, with
the transference of too much moisture to the surface of the body,
(iii) General conditions : tearing or rupture of Jocular spaces and
crypts.

When repletion (as from great plenty during fertile years)
develops after a long period of inanition (as from times of great
famine, in barren years), it is one of the most effective causes of
such illnesses.

395. — The causes of the evacuation {depletion) of matters
which jire normally retained. (1) Vigorous expulsive faculty,
{2) defective retentive faculty, (3) unfavourable quality of the
matter: (a) too heavy, because superabundant, (b) too distending
owing to flatulent action, (c) corrosive and acrid in quality,
(d) attenuation of texture making it too mobile and too easily
expelled, (4) widening of the excretory channels. This occurs
in the case of the seminal flow. It also occurs if they are torn

* Cf., repletion and depletion (442, 497, 502).

23 o THE CANON OF MEDICINE

longitudinally or transversely, or because their orifices become
too patent (in epistaxis) , from either extraneous or interior

causes.

396.— -The possible effects of evacuation ot this type are_ :
(i) The temperament becomes cold, because the matter is
lost which would otherwise increase that which maintains the
innate heat. (2) The temperament becomes hot, if the evacuated
material is cold in temperament, like serous humour or mucus.
(fl The temperament becomes equable like blood, if there is
undue accumulation of the heating bilious humour, so that the
heat becomes superabundant. (4) The temperament becomes
dry. This is always intrinsic in origin. (5) The temperament
becomes moist in a manner analogous to that mentioned m
regard to accidental increase in the body-heat. Namely, either
the evacuation of desiccant body-fluid has not been too great, or
the innate heat is too scanty, with the result that the aliment is not
adequately digested, and serous humour becomes relative y
increased. But a moist temperament of this kind is unfavourable
to the maintenance of the innate heat, and foreign heat will not
serve as a substitute for innate heat, because of the difference of

its nature. "

397* The effect of excessive evacuations on the members
of the body.—- (1) Coldness and dryness of their substance and
nature ensue, even though they receive extraneous heat, and
moisture beyond their need. (2) Diseases : obstruction of the
vessels due to undue dryness, and narrowing of the veins.
Convulsions and tetanic spasms may therefore arise.

398. When retention and evacuation are equally matched,
and occur at the proper times, they are beneficial, and maintain
the health.

8 106 Venery. Coitus.— Galen placed this in the first rank among the obli-
gatory causes of disease, but most physicians group it partly under exercise, and
-Dartlv under "evacuations" (excretions).

P It causes " dryness " of the body ; weakens the vegetative faculties m-
frigidateE ^usually) Sometimes the concomitant emotional excitement entails
a heating effect. (Joannitius).

Having now given a general description of the obligatory
causes of disease, we proceed to the facultative causes.

• B. 18. FACULTATIVE CAUSES OF DISEASE.

We now come to causal agents, not necessarily injurious,

to which the body is not inevitably exposed. They cannot be

classified either as natural or as contrary to nature. They

influence the body from without. Excluding the atmosphere, to

THE CANON OF MEDICINE 231

which one is necessarily exposed, such agents are referred to as
baths, friction, and the like.,

399. Influences on the human body from without act
in these ways :

I. By penetration into the body (400-414)

(a) Attenuated matter in the pores enters the body by its
own penetrative power.

(b) The tissues themselves draw it in through the pores.

II. The primary quality of the agent itself is able to
produce a change in the body. (415-431.) There are three
aspects of such a quality :

(i) It may be actual, e.g., an epitheme of cooling
character ; a plaster which is calefacient.

(ii) It may be potential. Here the innate heat stirs up
the power into actuality.

(iii) A specific property.

III. Things acting in both ways (a) producing a harmful
effect both externally and internally. (P) Harmful when applied
externally, but not when taken internally ; and vice versa.

Example of an agent which affects the body when applied
externally, but harmless when taken by the mouth : onions
applied as a plaster cause ulceration ; as food, they are harmless.
Example of an agent of a contrary kind : white lead. This is a
virulent poison when swallowed, but is harmless when applied
as an ointment.

Explanation of this. — (1) When a substance like onions is
taken as food, the alterative faculty breaks it up and changes its
temperament into a weaker one, until it is too weak to exert a
harmful influence. Hence there is no internal ulceration.
(2) When taken as food, such a substance is usually admixed
with other foods. (3) Its power is broken by being submerged
in the other moist substances present in the alimentary canal.
(4) A substance applied externally can be kept in one spot, but
when it is within the stomach it is kept moving about. (5) A
substance applied externally is usually applied very tightly and
closely, whereas within the body it is only just in contiguity
without any adhesion. (6) When a substance is taken internally,
its own natural power determines the quick accomplishment cf
digestion and quickly expels the excess lert after the bulk has
been converted into good blood.

The reason why the action of white lead is different is that

2 32 THE CANON OF MEDICINE

white lead is of gross nature and is made of coarse particles.
Hence it cannot penetrate, into the channels of the body from
without, and even if it did enter the skin it would not reach as far
as the channels of the breath or the principal organs. Taken in
by the mouth the matter is different, for then its poisonous
nature is at once brought out by the influence of the innate
heat upon it. Such an interaction could not take place ex-
ternally.

We shall probably refer to these considerations again, in
the Book of Simples. (Book II).

BALNEOLOGY
I

19. Baths. Friction. Exposure to the Sun.

§ 197. Points Relative to Water-Baths.

The bath-rooms : temperature of the air in the different rooms (temperate, warm,

hot, cool) ; mural decorations.
The bath-man.
The bath itself :

Quantity of water : full to immersion ; partial ; sitz, etc.

Temperature of water : hot, tepid, cold.

Duration of stay in the bath : long, short, medium.

Kinds of water employed.

Intrinsic quality (cooling, moistening, etc.)
The person bathing : relation to food : fasting or hungry ; immediately after a meal ;
soon after a meal ; at the end of the first stage of digestion.

State of the skin : dry, moist ; dropsical.

State of the humours and their quality (cold, immatured).

Frequency of bathing.

Season for open-air bathing.
Effects of the bath :

On respiration.

On pulse.

On innate heat.

On the strength (relaxing effects ; syncope; impotence).

On the humours : helping maturation ; drawing to surface ; diverting super-
fluities to different parts.

On the quality of the body ; dry, cold, moist.

On the general nutrition : making the body thin, stout, or weak. _
Special purposes of the bath. Treatment of hectic fevers ; for affections of the
stomach and spleen, etc.

400o Some say that bath-houses should be ancient fine
buildings, with vaults and arches, and roomy, airy, spacious
galleries, and furnished with sweet water. Others mention that
the bath-men should arrange the degree of heat to suit the tem-
perament of the bather.

§ 198.— The bath-house, the hammam, of Arabian life, agrees in
manner with that described among the ancients (e.g. the Romans).

THE CANON OF MEDICINE 233

In Lane's notes to the " Arabian Nights," he gives the following
description : — " The public bath comprises several apartments, with
mosaic or tessellated pavements, composed of white and black
marble, and pieces of fine red tile, and sometimes other materials.
The inner apartments are covered with domes, having a number of
small, round, glazed apertures, for the admission of light. The
first apartment is the disrobing room (mas lakh, or stripping-place :
Burton). (Tepidarium, because the air is tepid.) In the centre of this
is a fountain of cold water. Next the walls are wide benches or plat-
forms, encased with marble. These are furnished with mattresses and
■cushions for the higher and middle classes, and with mats for the
poorer sort. The inner division of the building occupies nearly a
square : the central or chief portion of it is the principal apartment, or
hararah, which generally has the form of a cross. In its centre is a
fountain of hot water, rising from a base encased with marble, which
serves as a seat. One of the angles of the square is occupied by the
ante-chamber of the hararah. A second angle has the fire and the
boiler over it. A third angle has a small chamber, containing
a tank of warm water fed by a spout in the dome (cf. calidarium).
The fourth angle has two taps side by side, one hot, one cold. A
small trough is beneath, and before that is a seat (cf. frigidarium).
The inner apartments are heated by the steam rising from the
fountain and tanks and by the contiguity of the fire. The chamber
of the first-named angle is not as hot as the hararah, and has a
door intervening. This chamber is used for disrobing in cold
weather.

" In their atmosphere, the four apartments of the Hammam
represent the four seasons — Autumn and Summer, and Winter and
Spring.". (Night 452).

" The bather enters the hararah wearing wooden clogs, a large
napkin round the loins, a second round the head like a turban,
a third over the chest, and a fourth covering the back. The attendant
removes the towels except the first, and proceeds to crack the joints
of his fingers and toes, and several of the vertebrae of the back and
neck ; kneads his flesh, and rubs the soles of his feet with a coarse
earthen rasp, and his limbs and body with a woollen bag which
covers his hand like a glove. After which the bather plunges
into the tank. He is then thoroughly washed with soap and water,
and fibres of the palm-tree, and shaved, if he wish it, in the fourth
chamber. Then he returns to the antechamber, and here he gener-
ally reclines upon a mattress, and takes some light refreshment,
while one of the attendants rubs the soles of his feet, and kneads
the flesh of his body and limbs, previously to resuming his dress.
During this period of rest, a pipe and a cup of coffee is often taken.
The operations in the antechamber are the ' restorative friction '
of the text and of Greek and Roman baths. Before the dress is
resumed, oils or ointments are rubbed in, and fragrant powders
sprinkled on the skin."

234

THE CANON OF MEDICINE

Rooms in the private baths of the Alhambra Palace, (a) The Sultan's bath.
Through the archway on the left is seen (6) the Calidarium. The " rest-room " of
the same suite is shown as an " initial " to 751.

§ 199- — 'Sir Thomas Arnold, in his recently published work,
" Painting in Islam," 107 (1928, p. 88) quotes some medical authors
who speak of the propriety of mural decorations in the rest-room.
(a) The ideal bath " should contain pictures of high artistic merit
and great beauty, representing pairs of lovers, gardens, beds of
flowers, fine galloping horses and wild beasts, for pictures such as
these are potent in strengthening the powers of the body, whether
animal, natural, or spiritual." (b) " All physicians, sages, and wise
men are agreed that the sight of beautiful pictures gladdens and
refreshes the soul, and drives away from it melancholic thoughts
and suggestions, and strengthens the heart more than anything
else can do, because it rids it of all evil imaginings." (c) " Beau-
tiful pictures in bright, cheerful colours. These they divide into
three kinds since they knew that there are three vital principles
in the body — the animal, the spiritual and the natural. Accordingly
they painted pictures of each kind, so as to strengthen each one of
these potentialities ; for the animal power they painted pictures
of fighting and war and galloping horses, and the snaring of wild
beasts. For the spiritual power, pictures of love and of reflection
of the lover on his beloved, and pictures of their mutual recrimina-
tions and reproaches, and of their embracing one another ; and
for the natural power, gardens and beautiful trees and bright flowers."
(d) " When in a beautiful picture harmonious colours such as
yellow, red and green, are combined with a due proportion in their
respective forms, then the melancholy humours find healing, and the
cares that cling to the soul of man are expelled, and the mind gets
rid of its sorrows, for the soul becomes refined and ennobled by the
sight of such pictures."

THE CANON OF MEDICINE 235

401. Natural action of the bath. The air of the bathroom
has a warming action, the , water of the bath has a moistening
effect on the body. The first change in the body is to cool and
moisten ; the second is to warm and moisten ; the third is to
make the body warm and dry. It is useless to listen to those who
assert that water taken internally does not moisten the interior
tissues.

402. Changes and later effects of the bath. These are (a)
accidental, (b) essential.

1. Cold air bath. — This disperses the innate heat greatly,
and so dries the substance of the tissues. It disperses the natural
(normal) fluids very greatly, though it increases the extraneous
fluids.

2. Very hot water bath. — The pores close ; there is goose-
flesh. The moisture does not enter the body, and there is not
much dispersal of the innate heat. But the water sometimes adds
to the warmth of the body and sometimes cools it. To have the
former effect, the water must be very hot.

3. Subtepid bath. — This cools and moistens the body. As
the water cools down, the air of the bathroom becomes less
warm, and the effect of the cooling in both directions to which the
body is now exposed is to contract the abdominal viscera.

Cold bath.— When taken while fasting, it imparts warmth and moisture If
taken after a meal, it will make the body cold, and remove moisture

_ Hot bath.— When taken while fasting, it is attenuant and refrigerant and does
not impart moisture If taken after a meal, the bath is heating and moistens the
body. — (Hippocrates.)

Warm bath.— This relieves lassitude, is soothing, and has a warming and
softening effect. It dispels plethora, and removes flatulence from wherever it may
have lodged It favours sleep, and promotes digestion.— (Haly Abbas.) It opens
the pores It induces plumpness of the body. It is beneficial for all— men, women
young, old, rich, poor. The best time for it is before food, and after exercise —
(Aegmeta.)

403. _ The frequent use of such a bath will have a refrigerant
effect. This is because (i) water is fundamentally cold in nature,
and even warming of it will not ensure continuance of the
" accidental " (scholastic significance) heat, the natural quality
remaining, and this natural coldness enters the body and makes it
cold, (ii) Whether hot or cold, water is still " wet," and wets the
body (interiorly), so, imparting much moisture, it binds the
innate heat even to the degree of extinction.* Consequently
the body becomes cold.

Such a bath may have a warming effect if (a) the. aliment
previously taken has not yet digested, (b) there is a cold humour

* As water quenches fire.

23 6 THE CANON OF MEDICINE

present in the body which is not yet completely matured. For
the bath will help the digestion of the aliment, and the maturation
of the humour. ■ .

404 Sw/* 0/ j&» <tf /^ /«»* 0/ /£* bath.— If the skin be dry
at the time of the bath, dropsy or relaxed conditions would be
benefited. If the skin be moist to commence with, the bath will
have a moistening effect.

405 Duration of stay in the bath. — Dryness results it the
person stay a long time in the bath. This is partly because of loss
of water by the sweating and with the dispersal of the breath so
induced. 'A short stay-in the bath will produce a moistening
effect, if the skin be wiped dry before sweating begins^

406 Relation to meals.— To enter a bath fasting will
render the body extremely dry, and make the person thin and
debilitated. To enter the bath after a heavy meal, on the other
hand, will make a person stout, by drawing the humours towards
the subcutaneous tissues. Moreover it removes the obstructions
by transferring the undigested aliment from the stomach to the
tissues. To enter the bath at the moment when the first digestion
has ended and before a sense of hunger returns is beneficial and
produces a medium degree of stoutness.

407 Special therapeutic uses. Bath treatment of hectic fever.
—If the bath is taken for a moistening effect the person should
be entirely immersed in the water, unless he is too enfeebled or
his strength will not allow of it. The air of the room should be
temperate— neither hot nor cold, but gently moist. The water
of the bath should be thrown freely about in order to disseminate
the water-vapour through the air and so fill the air with moisture
The duration of the bath should not be long. The patient should
be lifted out of the water and rubbed down gently, himself
making no exertion ; and he should be laid at once on the couch
(in the bathroom^ and there be anointed with oil (to increase the
moisture of the skin and retain in the pores the aquosity which
has already gained entry into the skin, thus fixing it within the
skin^ using cool perfumed oil. He should then he in. the
tepidarium (the disrobing room) for an hour until the respiration
subsides to the customarv rate. After that, he is anointed, robed,
and taken into a room (dining-room, 1595 ed.) where he may
receive a small draught compounded of humectants, such as
barley water and asses' milk. .

' Disadvantages.— Such patients should not stay too long in
the bath, as there is a risk of syncope, because it renders the heart
" hot " (and therefore disperses the " breath ") and sets the

THE CANON OF MEDICINE

237

bilious humour in motion ; it produces nausea ; and other ill-
effects. It causes morbific matters to gravitate into the debilitated
organs. It has a relaxing effect and is injurious for the nerves.
It disperses the innate heat. It removes the appetite for solid
food. It weakens the power of sexual intercourse.

[Aegin'eta says : natural baths are largely desiccant and calefacient, and are
therefore good for people of humid and cold temperament].

408. Action of baths in virtue of mineral constituents in the
water. — Waters of this kind occur in nature, or may be repro-
duced artificially. They are all strongly resolvent and attenuant.
They make the tissues flabby, and prevent humours from passing
into abscesses. They are beneficial for the guineaworm and
" Indian vein."

Mineral Baths in the Middle Ages 12 (p. 270).

Aluminous waters [Alum=MgS0 4 +FeS0 4 : "hair-alum,"
according to Adams 74 ] benefit cases of haemoptysis, melaena,
menorrhage, procidentia ani or uteri, repeated causeless mis-
carriage, cachexias, undue sweating, causeless vomiting. They
have a cooling and drying effect.

Bitter waters have a heating and drying effect.

Bituminous waters ("judaic waters ") occasion fulness of
the head. The person must therefore not immerse his head in
the bath or stay too long in it. They render the temperament
warmer, especially that of the uterus, bladder and colon. They
are all harmful and heavy. [They soothe if persevered with:
Aegineta.]

2 3 8 THE CANON OF MEDICINE

Chalky waters have a cooling and drying effect.

Copper-containing waters are beneficial for the mouth,
tonsils and uvula ; for relaxed ocular tissues ; for humid
affections of the ears.

Ferruginous waters are beneficial for the stomach and
spleen. . (They should be entered gradually so as to allow the
impression of the water to sink deeply into the body while it is in
a relaxed state : Aegineta.)

Medicinal baths, prepared with laurel leaves, stavesacre,
juniper berry.

Nitrous (=Na 2 CO s : Adams 74 ) baths and saline baths are
beneficial for the head and chest when humours are constantly
flowing into them ; for wateriness of the stomach, for dropsy, for
swellings left after diseases, and for collections of phlegm.

Aerated waters, ferruginous and saline waters are beneficial
for diseases depending on coldness and moisture, for pains in
the joints, for podagra. They benefit relaxed persons, asthma,
renal disease, carbuncles, ulcers ; they are very beneficial in
cases of fracture.

Sulphur baths. These soothe and warm the nerves and
relieve pain, lassitude and convulsions. They cleanse the
surface of the skin from furuncles and old bad ulcers and purple
marks ; they benefit pannus, vitiligo, lepra. They disperse
morbific matters descending into the joints, the spleen and the
liver. They are beneficial for the womb when unduly hard.
They reduce the tone of the stomach and banish the appetite.

409. Thermal baths. — Persons desiring to use thermal
baths should bathe quietly, gently, and allow the waters to play
gently over the relaxed body ; laving, not splashing ; and in this
way the interior organs are benefited.

The subject of baths will be considered further in Part III,
and again when discussing the use of cold water as a drink.

2,0. The Influence of Sunbaths ; Sandbaths ; Oilbaths ;

Showerbaths.

41 0„ Immersion in hot sand, oil baths, spraying of water
over the face ; standing or running or walking rapidly, or
jumping in the heat of the burning sun — all these are powerful
agents for removing superfluities, and for producing sweating,
dispersing flatulence, and lax swellings and dropsies. They are

THE CANON OF MEDICINE 239

beneficial for asthma, for orthopnoea. They invigorate the brain
(whose temperament is cold) and relieve inveterate " cold "
headache.

If the seat of the bath is dry, and the floor is left wet, the
bath will benefit cases of sciatica, lumbar pain, uterine obstruc-
tion. It has a cleansing effect on the womb.

411. Sun-baths. — One must not remain too long in the
sun, or else the body will become dry, thick, and hard, as the sun
acts like a cautery upon the pore's of the skin, and obstructs the
outflow of the insensible perspiration. The sun burns the skin
more if one stands still in it, than if one moves about, and
so it inhibits the dissipation of the sensible perspiration still
more.

412. Sea-sand baths, in the sun, — These are more efficient
for drying the humours lodged in the skin. Such a bath may be
used in various ways : one may sit on the sand, or" bury oneself in
it, or sprinkle it over the body. In whatever way it is' employed,
the same beneficial effect is experienced in all the above-named
diseases. If the sand is sprinkled over the body, little by little, it
removes pains and other effects of insolation. In the end, there
is an extremely marked drying effect on the body.

413. Oil-baths. — These are beneficial in lassitude and
for persons suffering from long-standing cold fevers, especially
if there are pains in the nerves and joints ; for convulsions ; for
spasmodic diseases ; for suppression of urine. The oil must be
made hot outside the room. These baths are more beneficial
for the above conditions if the flesh of the jackal or hyssna is
boiled in iL If made as described, it will be an efficient remedy
for joint-pains and podagra.

Aetius gives : add a fifth part of heated oil to the water. Such a bath is highly
anodyne ; it relieves lassitude and nervous pains. Uses : for prolonged fevers •
for convulsions ; for retention of urine. '

414* Shower-baths, Douching, Spraying. — If water be
sprinkled on the face (or over the body) it restores the vigour of
the breath, when that has been lost by dyspnoea and by the
inflammatory changes in hot fevers. .This sprinkling is especially
beneficial for syncope, if rose water or vinegar be used. It
may restore the appetite. They are injurious to persons suffering
from catarrhs or " cold " headaches.

"He swooned away, and the Wazir sprinkled rose water on him till the
Prmce came to himself."— Night, 720 ; Burton, iv. 408.

Douching with emollient herbs is referred to in 719, 732.

2 4 o THE CANON OF MEDICINE

The Agents which alter the Several Qualities of the

Body.

i. Calefacients.

2. Refrigerants.

3. Humectants.

4. Desiccants.

5. Agents causing changes of form.

6. Agents causing obstructions of channels.

7. Agents which, open up the channels.

8. Agents causing roughness.

9. Mollificants.

10. Agents causing displacements of parts.

11. Agents preventing apposition of parts.

12. Agents preventing expansion of parts.

13. Agents causing abnormal movements.

14. Causes of numerical increase.

15. Causes of numerical decrease.

16. Causes of loss of continuity.

1 7. Causes of ulceration.

18. Causes of inflammatory swellings.
19-26. The subject of pain.

27. Agents producing retentions or evacuations.

28. Causes of over-repletion.

29. Causes of debility ; asthenia ; lack of vigour in members.

415. — I. Calefacients.

(i) Outward heat in various forms : summer heat ; artificial
heat ; baths of moderate temperature (the heating effect is produced
by both air and water) ; calefacient plasters or local applications.

(ii) Heat produced by movement. Exercise, but not in excess ;
gymnastic exercise which is not too vigorous or beyond the right
measure and duration ; moderate friction ; light massage with the
hands on the limbs ; dry cupping (wet cupping is infrigidant because
it removes heat from the body).

(hi) Heat introduced b'y the mouth. Adequate supply of nutri-
ment •/ hot aliments; hot or heating medicaments (i.e. via
oxidation within the body.)

(iv) Heat arising from emotional states : anger, gloom in a
degree less than would cause infrigidation ; moderated joy. Also
sleep and wakefulness in moderate degree.

(v) Heat derived from putrefactive processes. This is neither
the innate heat nor derived from combustion. The warming _ from
the innate heat is less in degree than that from combustion ; it can
occur apart from putrefaction and prior to a septic state. In the
case of putrefaction the heat from the foreign source lingers in the
body after the agent giving rise to it has left the body. This heat
unites with the moisture of the humours and alters their temperament
(in respect of moisture) in such a manner that it will no longer
respond to the temperament of the natural breath. The difference
between digestion and putrefaction is that in the case of digestion
the heat and moisture which are present in matter are altered ;
that is, instead of being accordant with the original temperament,
they are now accordant with another different one (J>).

THE CANON OF MEDICINE 241

In oxidation, moist substance is separated from dry by sub-
limation and evaporation, the dryness going into the residue.

In the process of simple calef action, the humours simply become
warmer without losing their natural breath.

(Galen's classification into five groups is represented by i, ii,
iii, iv and v of the above list.)

(vi) The state of the body. When there is sclerosis (takathuf)
of the surface, the body tends to become hot because the breath
(lit.. the steam, bakhr) is held in or imprisoned. When there is
rarefaction (takhalkhal) within the body, it becomes warm because
the " breath " (bakhr) then expands throughout the body.

The above section has been partly rearranged. The sub-headings are intro-
duced, as usual, for the sake of clearness.

Sclerosis. — This refers to the thickening of the skin, which occurs after long
exposure to the weather ; it becomes harsh, coarse, and presumably less pervious.

Steam. — Horses " steam " when they have been hard-worked. The exhaled
air appears like " steam." The urine and shed blood steam when they leave the body.
This steam is the substance of the breath, so that it is permissible to translate the
word accordingly. This steam, which pervades organs and tissues and tissue-
spaces and cavities, is the visible manifestation of the breath.

It is natural to think, then, that if the skin is so hardened that it will not let
this vapour out, the latter will accumulate in the body and make it hot, as happens
after severe exercise until the body " cools down." It is also natural to reason
that if the vapour is able to expand owing to laxity of the connective tissues, it will
impart a sense of glow to the body ; for everyone has experienced it.

Rarefaction. — When this term is applied to the skin it refers to a condition
opposite to " sclerosis " ; the skin is unduly soft, supple, and is evidently relaxed
instead of tight.

These considerations apply to sub-heading 5 of 416. See also 838.

§ 200. In modern language, the warmth of the body depends on
the relation between heat loss and heat gain. Heat enters the body
from (a) the external air or surroundings : warm air of summer,
artificially warmed air in winter, baths ; (b) heat derived from (i) food
and drink, (ii) exercise, (iii) toxic action of foreign matter (sepsis,
drugs); (c) heat fostered by preventing heat loss: clothing, sleep;
(d) local heat (fomentations, etc.) ; (<?) emotional influence.

Heat is lost from the body by (a) excreta : urine, faeces, skin
action, exhalation by the air expired ; (b) external conditions :
cold, wet.

Note that baths vary in their effect. An ordinary hot bath
(105° F.) renders the body warm; a brief immersion has a different
effect, a long continued immersion is depressant.

416. 2. Refrigerants.

1 . Artificial cold ; this is a refrigerant in act, as it is cold itself.
. 2. Potential refrigerants. Thus, when the body is hot at the
time of exposure to the agent, its heat becomes dissipated. Thermal
waters.

3. Calefacients. (a) Excessive : very hot air, thermal waters,
hot plasters and fomentations (which disperse the innate heat by

2 4 2 THE CANON OF MEDICINE

relaxing the body) ; ■ (b) moderate : staying too long in the bath ;
(c) agents at present hot but becoming cold later.

4. Excessive exercise : this disperses the innate heat unduly.
Excessive repose aggregates and strangles the innate heat, thereby
having an infrigidant effect.

5. Certain bodily states, (a) Great rarefaction relaxes the
body and. disperses the innate heat ; (b) extreme spissitudestrangles
the 'innate heat ; (c) excessive retention (has the same action) ; (d)
undue evacuation from the body, which destroys the material basis
of the innate heat and disperses the breath, and allows the effete
matters to become obstructions.

6. Mental states : great gloom, too much fear ; too much joy ;
great delight.

7. Aliment. Excess of food and drink ; cold aliments ; too .
little food ; refrigerant medicines.

8. Mechanical causes : tight bandaging of limbs for some
time, which prevents the innate heat reaching them.

9. Crudity ; the opposite of putrefaction.

(Galen's classification was : 4, 1, 3a, $b, insufficient food.)

417. 3. Humectants.

External : baths, especially if taken after a meal.

Diet : food taken to excess ; humectant articles of food ;
humectant medicaments.

Retention of that which should be evacuated.

Evacuation of desiccant humour.

Repose and sleep.

Joy in moderation.

Infrigidants (these cause the humours to be retained) ; cale-
facients (slight degree of warmth causes the humours to move).

418. 4. Desiccants.

External : cold congeals the humours and prevents the tissues
from attracting nutritive material ; it also constricts the channels of
the body, and so causes them to be blocked ; in consequence nutrient
material cannot reach it.

Great heat disperses moisture. Hence too frequent hot baths
have this effect.

Bathing in styptic waters has a desiccant effect.

Diet : insufficient food ; dry aliments ; desiccant medicaments.

Violent evacuations ; coitus.

Exercise.

Wakefulness.

Frequent emotional disturbance.

419. 5. Agents causing deformity.

Some of these agents come into play from the beginning of life,
because of a defect in the formative power of the sperm. Others

THE CANON OF MEDICINE 243

come into force later in life — namely at parturition, during the act
of traversing the maternal passages. Others operate after birth
(tight binders and wrappings). Others operate in infancy, before
the limbs are hard enough to enable the infant to walk (letting the
baby fall ; blows).

Diseases which characteristically produce deformities : leprosy,
paralysis, .nerve-lesions, phthisis.

Excessive deposition of fat ; an excessive degree of emaciation
(due to inflammation, or malposition, or from the coalescence of
ulcers).

420. 6. Agents causing obstruction of the channels.

(i) Foreign bodies in a channel : ' calculus, (ii) Too great a
quantity of material in a channel : loading with faeces', (iii) Altera-
tion in quality of material : grossness, viscosity, leech-like coagula
of blood, (iv) Formation of matter within the channels, whether
removable therefrom or becoming fixed therein, (v) Obliteration
of the orifices, (a) by cicatrisation after healing of an ulcer ; (b) by
formation of new tissue (e.g. proud flesh, fleshy warts) ; (c) by com-
pression by an inflammatory mass in the vicinity ; (d) by the
astringent effect of great cold or dryness (styptics) ; (e) by unduiy
marked retentive power; (/) by tight bandaging.

Obstructions are common in winter, because that is the season
when effete matters are largely retained, and because the cold itself
has an astringent effect.

421. 7. Agents which open up the channels.

Channels become dilated either from lack of retentive power
or from an excessive action of the expulsive facultv. For example
holding the breath. Medicines which are relaxing, hot, moist'
aperient and detergent. ' '

In short, all agents contrary to Group 6.

422. 8 . Agents producing harshness of the body.

. A medicinal agent may render the body harsh by its sharpness
(acidity), like vinegar and acetous waste matters ; or by dispersion
(like halcyonium= coral) and acrid waste matters ; or by styptic
action (which produces roughness because 'it is dry ; ex. : bitter
substances).

Infrigidants have this effect, by inspissation.

Terrene substances sprinkled over a limb like a dusting-powder
may exert such an effect.

423. 9. Mollificants.

(Fatty or) glutinous substances act in virtue of their viscidity ;
agents which mildly disperse the humours by attenuating them!
cause them to flow, whilst at the same time they carry off the dense
particles of matter in the apertures on the surface of the member.

244 THE CANON OF MEDICINE

424. io. Agents which produce displacements and luxations.

Displacements of parts are produced (i) by extension — a force
dragging on the member and pulling upon it until it is dislocated ;
(2) by some unexpected violent movement, aided by the throwing
of the whole weight of the body upon the member (e.g. luxation of
the foot) ; (3) by some laxity or moistness in a part. This happens
in tearing, in corrosion, or septic change or destruction of the sub-
stance of a ligament or nerve — e.g. in elephantiasis, sciatica.

425. 1 1 . Agents , which prevent parts from becoming

apposed.
Here belong — congenital factors ; grossness ; viscosity ; loose-
ness of joints ; dryness of humour in a joint ; spasm ; ulcers which
are only partially healed ; calculus.

426. 12. Agents which prevent parts from expanding.

Here belong — congenital factors, coarseness, spasm, cicatrisation
after healing of ulcers.

427. 13. The causes of abnormal movements.

(1) Dry intemperament may cause weakness (e.g. dry tremor)
or spasm (e.g. dry hiccoughs, or spasm). (2) Effete matters which
heat, or cool the surfaces of the muscles. (3) Interception of the
power which should have access to a member owing to some form of
obstruction. (4) Nocumental effete matter acting in virtue of its
coldness (e.g. rigor), or in virtue of pricking property (e.g. shivering),
or in virtue of interference with the innate heat, making it either
scanty or submerged, so that the surfaces of the muscles become cold,
and gaseous matter forms which seeks to be dispersed or expelled.
(Ex. : jerkiness, jactitation.)

In such nocumental matter, further, gaseous matter may be
deficient. This gives rise to the desire to stretch oneself. Or,
gaseous matter may be in excess ; and in this case, if the matter be
quiescent, one form of lassitude arises ; if the matter be mobile,
other forms of lassitude will arise, which we shall describe later (821).
If the nocumental character of the matter be more decided, shivering
ensues. If very strong, rigors and spasmodic contractions come on.
Should such matter which is held back in the muscles be gaseous,
jactitation or pulsatile movements arise.

428. 14. Causes of increase in size of body.

Abundant supply of aliments ; great vigour of attractive
faculties acided or not by friction or by calefacient plasters (e.g.
plaster of pitch and the like). A powerful formative faculty will
increase both the size and the number of tissue-components : e.g.
proud flesh, supernumerary fingers. If pathological material* be
formed, tumours, ganglia, " atheromas," steatomas, and warts will
form. (Costaeus, quoting Galen.)

THE CANON OF MEDICINE

15. Causes of numerical decrease.

(1) Congenital: matter* lessened in amount; faulty or defective
formative power. (2) Acquired : lack of nutrition during lactation
or later ; direct injury — cutting wounds, blows, mechanical destruc-
tion of tissue ; frostbite ; internal causes — eroding ulcers, septic
processes.

429. 16. Causes of loss of continuity.

(1) Intrinsic : Pathological body-fluids, having a consuming,
burning, moistening, relaxing, drying or cleaving action. Fluids
which pierce and force themselves into tissues and stretch them apart.
Gaseous matters also may force their way into, and stretch, tissues.
In each of these cases, the effect produced depends on (a) the force
of movement, (b) the abundance of the fluid or gas, (c) the greatness
of the expulsive power.

Similar in action to these are : vociferation, leaping exercises ;
opening of abscesses.

(2) Exterior. Traction by a rope or weight ; incision by a
sword ; burning by fire ; contusion by a stone ; rupture of a sac
by contusion ; perforation by an arrow ; punctured wounds (scorpion
wounds) ; bites by a mad dog, a viper, or a human being.

430„ 17. Agents producing ulceration.

The rupture of an inflammatory mass ; of a pustule ; of an
abscess. The bursting out of an ulcer.

431. 18. The causes of inflammatory swellings.

Causes relative to the material in a member : superabundance
of the four humours ; aquosity ; gaseous matter.

Causes in regard to the condition of a member. (1) Expulsive
power. (2) Weak retentive faculty, which disposes it towards har-
bouring waste matters. This varies with (a) the nature of the organ
or tissue (e.g. the skin is so created) ; (b) the texture of the member
(the looseness of the flesh behind the ears, in the neck, axilla, and
groin is favourable — -to deposition of matter) ; (c) the width of the
passages and orifices — too great and too narrow respectively ;
(d) low position of outlet ; (e) small outlet, so that the food residues
cannot get away. Some nocument may impair the power to digest
the food material coming to the part. Blows may cause the matter
to be retained in a member. Lack of exercise may prevent matters
from being dispersed as they usually would be. Too much heat
in a particular region may attract inflammatory processes — whether
it be the natural heat of the flesh or an unnatural heat (causing pain)
or heat produced by excessive exercise, or by some calefacient agent.

Inflammation may follow fracture, if the limb has also been
contused or crushed or stretched when setting the bone-ends.

* i.e., humours.

246

THE CANON OF MEDICINE

Inflammations often occur in connection with the teeth, as food
may collect in them, undergo infusion, and so become putrefied.
This may lead to an abscess.

19-26. The subject of pai.

ain.

These separate Chapters are here gathered into one, with the following sub-
divisions' : —

General discussion of the causes of pain.

Theory of the nature of pain.

List of the types of pain, and the explanation of each.

Agents which alleviate pain.

The effect of pain on the body.

The causes of pleasurable sensations.

How movement brings on pain.

How depraved humours evoke pain.

How gaseous substances produce pain.

ii.

iii.

iv.

vi.

vii.

viii.

ix.

432. General discussion of the causes of pain.

AIN is one of the unnatural states to which the
animal body (as a sensitive and living thing) is
liable. We begin with a general discourse
about it.

Pain is sensation produced by something
contrary to the course of nature, and this
sensation is set up by one of two circumstances
(a) a very sudden change of the temperament ; or the _ bad
effect of a contrary temperament, (b) a solution of continuity.

In saying " the bad effect of a contrary temperament " we
mean : the substance of the members of the body has a constant
temperament, and then a foreign temperament of contrary
character (hotter or colder) supervenes. The sensitive faculties
become aware of the change ; this is " pain." The law is that
there is no pain save as the sensation of contrariety produced by a
contrary thing. A temperament which is constantly unhealthy
does not produce pain, or arouse any sensation. That is to say,
if the temperament residing in the substance of the members is
bad, it destroys the original temperament so that the member is
as if it had always had this unhealthy temperament ; consequently
it neither produces pain nor is aware of it. The reason is that
before sensation can occur, the sense organ must become affected
by that which is sensed. But in this case the condition persists.
There is no change. So there is no pain. Suffering will only
occur if some contrary enters which, is able to alter the tempera-
ment to one not previously present.

That is why a person suffering from hectic fever does not
suffer as much as one who has a one-day or a tertian fever, despite

THE CANON OF MEDICINE 247

the fact that the heat of the first is greater than that of the others.
In the case of hectic fever the heat is persistent and situated in the
substance of the principal members ; in the case of tertian, the
heat comes from a hot humour, and so reaches those members
which retain their natural temperament. Should the humour
recede, the natural temperament will continue in the member, the
heat not being fixed in it unless the fever become hectic.

No inequable intemperament persists in a member except
according to a certain rule. Such a state may arise during the
best of health. Thus, should a person plunge into a bath in
winter, and lave himself with tepid water, he would shiver ;
which shows that it is harmful. For the primary quality of the
body is far from that of the water, and indeed contrary. After-
wards, however, it is beneficial and produces subjective satisfac-
tion. The cold influence lessens step by step until no longer
evident to the senses.

But suppose the person were to sit in the bath-house
another hour, the water would make his body hotter. And yet in
spite of that, if this same tepid water of the above bath were
suddenly thrown over him unexpectedly, shivering would result
and the water would seem cold to him.

If we study such things carefully, it will be clear that though
unhealthy inequable intemperaments form one of the groups of
causes of pain, yet not every one of such intemperaments actually
does so. A hot temperament is in itself able to cause pain, and
so can a cold one ; but a dry temperament causes pain only
secondarily, and a moist one is painless. For heat and cold are
both active qualities ; dryness and moisture are passive. So that
in one case the impression on the body is active, in the other it is
passive.

Dryness is a cause of pain secondarily, if another kind of ■
agent comes into play, as e.g., loss of continuity. Dryness itself
may be a cause of loss of continuity, in virtue of its power of
producing great constriction of a channel.

433. Theory of the nature of /pain. According to Galen, all
this can be reduced to the one essential thing — loss of continuity
and nothing more. A hot thing only causes pain by breaking
continuity of a part ; a cold thing also only causes pain by
breaking the continuity of function or of a part ; it exerts such an
astringent and aggregating effect that the particles are drawn
together towards a certain place and agglutinated ; and, in
consequence separated off from their surroundings. In some of
his writings, he seems to hold the opinion that all sensibles are

24 8 THE CANON OF MEDICINE

deleterious from the very fact that in order to experience a
sensation there must be a cleavage of particles one from another-
agglutination of some entailing cleavage of others ; ; the fact o
cleavage accounting for the sensation called pain. A black
obiect which gives a painful impression to the sense of sight does
so because its blackness is due to an extremely close aggregation
of particles ; whiteness is due to the particles being widely

A bitter, salt, or sour thing, which gives a painful impression
to the sense of taste, does so because such things produce vigorous
dispersion of particles. Pungent things do so because they
aggregate ver/vigorously, and are therefore no doubt followed
bl dispersion. So too, with odours ; and sounds-where the
movement of the air impinging in the external auditory meatus
gives rise to a painful sensation. _ .

To explain it according to my own view :— It is the trans-
mutation of the temperament of a part which determines the
presence of, and the kind of, pain lft^g *^^^
there is loss of continuity or not. This is best proved by Natural
Science, but the following brief explanation may be given here.
We mav therefore say : —

Pain occurs in a member which is of homogeneous structure.
Solution of continuity cannot occur except in members wh^W
not of homogeneous structure. Pain occurs in states of the body
where there is no loss of continuity of particles. Hence loss .f
continuity is not a condition on which the appearance of pain
depends. An intemperament will produce it. Cold produces
pain if it constricts and agglutinates particles, and the part is
cold throughout its substance ; solution of continuity does not
occur at the site of infrigidation but at the distal parts of the
infrigidated places. Again, pain is the sensation of a sudden
impression by the contrary qualities. It is the fact that they are
contrary, that accounts for the pain. . ,,

Does one not observe how a person who experiences cold to
a degree enough to alter the temperament will sense thechange
in his temperament and also feel pain without there being any
question of loss of continuity? where indeed such a loss is
impossible ? It is clear then that a sudden change of tempera-
ment will cause pain just as loss of continuity does Pain
Souses heat, and affects the innate heat, and this makes the pain
greater^still.^ ^ ^.^ ^ f g & s thing

which provokes the sensation of pain. But it is not really pain.

THE CANON OF MEDICINE 249

It is a sum-total of .things which are undergoing spontaneous
breakdown.

A doctor ignorant of all this, and striving to relieve the pain,
may make wonderful mistakes, and fail in his object.

434. List of the types of pain and the explanation of each.
There are fifteen kinds of pain* (rearranged alphabetically) :

Boring

Heavy pain.

11.

Relaxing.

Compressing.

Incisive.

12.

Stabbing.

Corrosive.

Irritant.

*3-

Tearing.

Dull.

Itching.

14.

Tension.

Fatigue-pain.

10.

Pricking. '

i5-

Throbbing

1. Boring pain. The cause of this pain is the retention
of gross matter or of gas between the tunics of a hard and gross
member (e.g., the colon) and so continually goading it and
tearing its parts asunder, boring into the interstices like a
gimlet.

2. The pain of compression. This is produced by fluid or
gas, when it is confined in too small a space in a member, and so
compresses or squeezes the tissues.

3. Corrosive pain proceeds from the presence of material
between the muscle-fibres and their sheaths, stretching it till it
breaks not only the continuity of the membrane, but also that of
the muscle therewith.

■ 4. Dull pain. The cause is threefold : (1) the tempera-
ment may be too cold ; (2) occlusion of the pores so that the
breath (of the sensitive faculties) which should come to the
member cannot do so ; (3) overfulness of the (locular spaces or)
cavities.

5. Fatigue-pain. This is produced (1) by undue toil —
laborious toil, (2) by a humour which produces tension (in
tensive lassitude), (3) by a gaseous substance which produces
inflative lassitude, (4) a humour of biting properties (ulcerative
lassitude). These pains may arise out of various composite
states, as has already been stated in the appropriate places.

* In regard to the kinds of pain, it is of interest here to recall the eight hinds
of pain inherent in hiiman lije, given in the Nirvana Sutra : (i) Birth pangs (Shoku :
Japanese; jatir-duhkham : Sanskrit); (2) The pains of age (Roku : jara-duhkham) ;
(3) The pains of disease (Byoku ; vyadhi-duhkham) ; (4) The pain of death (Shiku ;
marana-duhkham) ; (5) The pain of parting with loved ones or things (Aibetsuriku ;
priyaviprayoge-duhkham) ; (6) The pain of meeting with what one dislikes (Onzoeku ;
apriya samprayoge-d) ; (7) The pain of not obtaining what one seeks (Gufutokku) ;
(8) The pain of the five elements ; that is, the body itself produces pain (Goonjoku).
(The Sanskrit of the last two terms is length}'). — Ishizuka's notes to Honen. "
p. 446.

25 o THE CANON OF MEDICINE

Lassitude as a result of several combined states, is called in
flammatory lassitude, which is a composite of tensive and
ulcerative lassitude (see 824). -

6. Heavy pain. In this case there is an inflammatory
process in an insensitive member such as the lung, the kidney or
spleen. The weight of the inflammatory deposit drags on the
tissues and surrounding sentient fascia and on its point of
attachment. As the member is dragged on, the fascia and its
point of attachment experience the sensation. The cause_ of
the Dain may be that a sentient member has had its sensation
destroyed bv the disease, so that the weight is felt, but actual
pain cannot' be felt any longer (e.g., cancer at the mouth of the

stomach). .

7. Incisive pain. This proceeds from a humour or sour

quality. . -

8. Irritant pain. This is produced by a certain type ot
change in the humours (harshness, roughness).

9. Itching pain. This is produced when a humour is acrid,

sharp, or salt. .

10. Pricking pain. The agent producing this is material
similar to that which causes boring pain ; it is retained in an
organ of similar type (to that which is the seat of boring pain)
for a time and then ruptures it. 1 • •

1 1 . Relaxing pain proceeds from matters accumulating in
and stretching the belly of a muscle— not its tendon. It is only
called relaxing if the belly of the muscle is more lax than the
nerve, tendon, or enveloping membrane.

12. Stabbing pain. This is the result of transverse
stretching in membranes, as if their continuity were being
separated, by a humour. It may be an equal or an mequal
sensation. In the former case, all the members of the body are
uniformly affected. In the latter case, there are four possibilities :
(1) Inequality in hardness or softness between the tissue with
which the membrane is covered and the membrane itself. Ex. :
the clavicle or costal pleura ; in a case of inflammatory process
travelling from the pleura towards the upper parts of the chest,
the pain is felt in the collar-bone, (ii) Inequality of movement
of the component parts (e.g., the diaphragm and the p eura or
peritoneum over it), (iii) Inequality of nature between the parts
and the member, (iv) Unequal distribution of nocument among
the parts and the member affected, in that it affects one and not

another. . . . c

13. Tearing pain. Proceeds from the interposition ot

THE CANON OF MEDICINE 251

humour or gas between bone and periosteum, or from cold which
strongly constricts the periosteum.

14. Tension pain. This is produced by a humour or gas
stretching the nerve-fibres or muscle fibres asunder.

15. Throbbing pain. The cause is a hot inflammatory
process. A cold inflammatory process, of whatever type, is either
hard or soft, but sets up no pain unless it changes into a hot
inflammation. Throbbing pain arises in a hot inflammatory
process if the adjoining member is sentient, and has pulsating
arteries round it. A member which is healthy does not sense
their movement, because they are deeply situated, but their
pulsation sets up pain as soon as an inflammation arises in the
member.

435. Agents which alleviate pain. There are three groups
of agents which alleviate pain : (1) Some contrary to the cause of
pain — which removes the cause. Ex. : anethum, linseed, made
into a poultice and applied over the painful place. (2) Any
agent which counteracts the acrimony of the humours, or soothes,
induces sleep, or dulls or soothes the sensitive faculties and
lessens their activity. Ex. : inebriants, milk, oil, aqua dulcis,
etc. (3) An agent which infrigi dates and dulls the sensation in
the painful part. Ex. : all narcotics and somniferous drugs.
The first of the three is the most certain.

This subject is referred to again at the end of Part IV.

436. The effect of pain on the body. Pain dissipates the
bodily strength and interferes with the normal functions of the
organs. The respiratory organs are inhibited from drawing the
air in, and consequently the act of breathing is interfered with,
and the respiration becomes intermittent, or rapid, or altogether
unnatural in rhythm.

The organs are first made hot, then cold ; this is because
some of the breath and vitality is dispersed and escapes.

437. The causes of pleasurable sensations. The agents which
produce pleasurable sensations fall into two groups. (1) Where
an intemperament suddenly becomes equable and the senses
become_ aware of the change. (2) Where there is a sudden
restoration of the natural continuity.

Sensation depends on sudden change, whether painful or
pleasurable. Pleasurable sensation is to sense harmoniously ;
and this act of sensation is performed by the sensitive faculties.
It is a passive act. One experiences pleasure or pain according
as the sensation is harmonious or disharmonious. The fact that
the sense of touch is the most elementary (crude) of all these

252 THE CANON OF MEDICINE

senses accounts for it retaining the harmonious or disharmonious
impress longer. When that which comes to the sense of touch
is harmonious with nature, the pleasurable sensation is greater ;
and if the agent is disharmonious, the painftd sensation is greater
than would be the case with the other faculties.

438. How movement brings on pain. Movement and
exercise induce pain when nerves are stretched thereby, or when
muscles become contused or lacerated thereby.

439. How depraved humours evoke pain. Depraved
humours" evoke pain either by reason of their qualities (for
instance, acridity), or by reason of their being abundant (thereby
stretching the fibres of a tissue of making the organ heavy) ; or
for both reasons together.

440. How gaseous substances produce pain. Accumulations
of gas may become painful when they cause a part to be greatly
distended. Gases may accumulate in (a) hollow viscera (e.g., m
the stomach : gastrectasis) ; (b) the membranes over organs, or
nerves (e.g., colicky pain from stretching of the nerves of the
intestinal wall) ; (c) the sheaths of muscles, serous membranes,
or periosteum ; (d) the subcutaneous tissues (the place between
the muscles and the loose fascia or skin); (e) internal members
(e.g., the muscles of the thorax). _

Gas may be dispersed rapidly, or only after a time. This
depends on the amount, and whether coarse or fine, and whether
the member itself is dense or rarefied in structure.

27. Agents which bring about Retention or Discharge.

441. It is easy to know the causes of retention or discharge
if one ponders well over what has already been said about reten-
tions and evacuations. The reader should therefore turn back
and carefully re-read what has been written about it.

28. The Causes of Over-Repletion (Plethora).

Plethora.— ' Passive congestion " is over-repletion with blood ; it is associated
with stasis.— " Active congestion" is the equivalent of waram, _ apostema. —
Oedema is over-repletion with lymph (serous humour) ; it is associated with. stasis
in the lymphatic channels or serous cavities. The practical result is that the chan-
nels cannot drain or empty within the available time.— Hypertension is a form of
plethora.— Corpulence is over-repletion with fat, namely in the connective-tissue
spaces. One practical result of this is that supervening disease produces greater
affliction than otherwise, as was written in the Charaka- (i. 236) .-Plethora of the
connective tissue spaces with a mucoid change m the fluid may produce the appear-
ance of obesity. This peculiar change is met with in the female sex ; it fluctuates
in degree from time to time, and may appear or disappear within a few days.

Intestinal stasis is over-repietion of the large intestine. -,,+,,+

It' may be noted that the effect of stasis anywhere is to interfere with that

THE CANON OF MEDICINE 253

flow of breath which is essential to health, or even life. The breath is " choked "
or " strangled." The faculties are also at a disadvantage, for their free operation
is conditional on free flow of breath through aU parts of the body —In modern
terms, oxidative processes are retarded or arrested.

442. The causes are extrinsic and intrinsic.

1. Extrinsic (primitive), (a) A dietary (fluids as well as
solids) which gives rise to much moisture beyond the heeds of the
body ; matter accumulates in the body, and interferes with the
action of the emunctories. (3) Taking baths frequently, especially
after meals, (c) Repose ; ceasing to take exercise ; ceasing to
secure the usual evacuations. These prevent the resolution of
material in the body, (d) Improprieties in eating and drinking ;
depraved regimen.

2 . Intrinsic, (i) Lack of digestive power, so that the aliments
are not completely utilized, (ii) Feebleness of expulsive faculty,
(iii) Undue vigour of retentive faculty, so that humours are
caused to linger in the body, (iv) Narrowing of the excretory
channels.

29. The Causes of Asthenia and Debility of a Member.

443. Weakness may affect (i) the body of the member
itself ; (ii) the breath, which conveys power to it ; (iii) the faculty
of the member.

(i) The following produce weakness in the member itself :
{a) A persisting intemperament, especially a cold one.
For even though the member receive some heat, the cold in-
temperament produces an effect like stupor in it, because it
breaks up the temperament of the breath— just as happens when
a person stays too long in the bath, and especially when such a
procedure brings on syncope. A dry intemperament has an
inspissating effect, and acts by preventing the faculties from
functioning in the member. A moist intemperament relaxes and
obstructs.

(b) One or other of the composite diseases.

(c) The most important in all-in man) is neither nocument,
nor malady, nor pain. It is an attenuation of texture in the peri-
pheral nerve-fibres of the member, for both vegetative and
voluntary actions depend for their achievement on° these fibres
in all their ramifications. The retentive power which is necessary
to secure efficient digestion depends on the condition of these
fibres in the stomach.

(ii) Weakness of the breath itself. This will occur if it be of
bad temperament. There may also be dissipation of the breath,

254 THE CANON OF MEDICINE

after an evacuation corresponding. It is also weakened by an
abnormal mode of depletipn.

(iii) Weakness of the faculty. This depends on the number
of actions and the number of times they are repeated. The breath
is dispersed at the same time. Moreover loss of breath accom-
panies every agent which produces asthenia.

444. The causes of asthenia may be classified in another
way, so as to include the remote causes with them — the causes
of causes. We then consider (i) causes of intemperament ;
(ii) causes arising from decomposition changes in the air, in
water, and in the aliment • (iii) causes which cause the breath to
escape, or become confused, or, as it were, shaken up. Nothing
disturbs the breath, or causes it to escape as effectively as does a
bad smell, such as the fetor from putrid water, or the presence
of poisonous vapours in the air, or in the body. [Under such
circumstances, the instinctive action is immediately to " hold the
breath."]

445. Evacuations as a cause of weakness. For instance, loss
of blood ; diarrhoea, especially of thin attenuated fluid ; the
sudden withdrawal of copious dropsical effusions by paracentesis ;
the opening of a large abscess with sudden- withdrawal of much
pus — whether the opening is by nature or by surgical inter-
ference ; excessive sweating ; severe exercise.

446. Severe fain disperses the breath and may alter its
temperament. The chief kind of pain likely to have this effect is
that from distension, or incisive pain — especially in the pit of
the stomach. Any pain in the region of the heart will disperse
the breath.

447. Fevers should also be included among the causes of
asthenia. They act either by dispersing the breath, or by loss of
blood, or through producing a change of temperament.

448. Widening of the pores often aids in producing
asthenia. Long continued semi-starvation has the same effect.

449. Weakness in one member or in a part of a member
may cause weakness of the whole body, as is seen in the case of
defective function of the cardiac orifice of the stomach, which
produces general weakness of the body. Or, if a person suffers
severely from some cardiac or cerebral trouble, shortness of
breath rapidly supervenes on very slight provocation.

450. Further, a cause of weakness may be that one has
endured many illnesses.

451. When one member is weaker than another from
birth, or when it is by nature weaker in itself (e.g., the lung, or

THE CANON OF MEDICINE

2 55

brain), then it is receptive for matters which the stronger mem-
bers reject or discard, or eliminate. The brain would suffer in
this way were it not for its position, whereby nothing comes to it
which it cannot tolerate, even its virtues cannot persist there.

END OF THESIS II.

C. Retributive or Expiative Causes of Disease.

§ 201. The idea that illnesses were a form of " judgment " or
punishment, or retribution for misdeeds, was formerly widespread,
but is not regarded seriously in modern Medicine. In the case of all
peoples who hold the Buddhist belief in karma, this ancient idea
holds_ good because every event, good or bad, in the individual life
is believed to be the outcome of events in a past life — whether in this
particular existence or in a previous incarnation. Wherever the
theosophical teachings hold, the same view would be held. Moreover,
in Islam there is no difficulty in the idea because " there is no second
cause," and as is written in the Mesnavi, in speaking of Izrail, the
angel of death, God is said to " operate by disease and sickness, and
men will not look for any cause beyond these diseases " — in virtue of
the truth of text (Quran 56, 84) " He is nearer to you than ye are ;
yet ye see Him not."

Ghazzali, in his " Alchemy of Happiness " says : "illness is, so to speak, a
cord of love by which God draws to Himself the saints concerning whom He has
said, ' I was sick and ye visited Me not.' Illness itself is one of those forms of
experience by which man arrives at the knowledge of God. As He says ' sick-
nesses themselves are My servants, and are attached to My chosen.' "

During mediaeval Christian times pandemics were regarded as
the manifestations of divine wrath, and the incidence of illnesses is
sometimes still explained in similar terms in modern Christianity, the
microbic and other tangible causes of disease being taken simply as
the instruments whereby the event is achieved. (Cf. § 113.)

As in the case of the idea of " fate " and " destiny," the subject
is apt to be viewed incorrectly. Illnesses are sometimes evident
warnings ; sometimes they belong to the category of expiation,
whether in relation to others or to the victim himself. In any case,
diseases may be regarded as in some way connected with that
experience of life which the sufferer has himself to undergo. In
Thomistic terms, such would be the " final cause " of disease.

In the life of Saint Lydwine of Shiedam, 124 we read how a cele-
brated physician, Godfried de Haga, endorsed and deferred to " the
divine law that every malady is an expiation ; that if God does not

256 THE CANON OF MEDICINE

regard the expiation as satisfied, the course of the illness cannot be
altered by the art of medicine. Cure cannot result from his treatment
unless his intervention coincides with the completion of the expiation
which has been imposed on the patient by his Lord." *

In modern times this belief is manifested as a conviction in the
pastoral instructions to the Catholic medical man that he is not
entitled to continue his ^ministrations on a patient gravely ill unless
his (Catholic) patient has fulfilled his spiritual duties within a certain
number of days of the onset of the severe symptoms.

"Hay muchos decretos eclesiasticos que prohiben a los medicos
visitar mes de tres veces, si el enfermo no se ha confesado." — •
(Vilariho, 142, p. 645.) _

The following advice to the patient himself is less narsn to
appearance : " first when thou feelest any indisposition, accept it
as a dispensation of the love of My Heart. . . . Afterwards, unite
thy sufferings with Mine. ... If thy infirmity increases offer to
Me thy body as a living victim. ..." (Arnold, xvi)

This teaching leaves no room for doubt about the true answer
to the oft-aired question, " should the doctor tell ? " (his patient that
his illness is likely to prove mortal).

* It was subsequent to the named physician's life-time that Paracelsus wrote the
words actually quoted, adding " when the time for redemption has come, the patient
will then find the physician through whom God will send him relief." Paracelsus
classified the causes of disease under five headings : those arising in morbid states
of the body ; those belonging to the category of poisons (intoxications) ; those
arising from " astral " origins ; spiritual causes (passions, disordered thoughts,
morbid imagination) ; and retributive. = 8 a (p. 199, 221).

THESIS III. THE EVIDENCES OF DISEASE

i. General Remarks about Symptoms and Signs

" The science of the diagnosis of disease by internal symptoms is founded upon
six canons : (i) the patient's actions, (2) the waste of the body, (3) the nature of the
pain, (4) the site of the pain, (5) swelling, (6) the effluvia given off by his person." —
Night 45 1." 1

" A physician who is a man of understanding looketh into the state of the body
and is guided, by the feel of the hands, according as they are firm or flabby, hot or
cool, moist or dry." — Night 450.

452.

Y means of the symptoms and signs of the three
main states of the body (health, illness, neutrality),
we obtain information as to the present, the past
and the future of the patient's state. Knowledge
of his present state, says Galen, is of advantage
to the patient alone, showing him what he must
do ; knowledge of the past is advantageous to
the physician alone, as proving him to excel in
his art, so that his advice becomes worthy of respect (because
reliable) ; knowledge of the future serves both purposes — it
is advantageous to the patient because it guides him along the
road he should follow, and it is advantageous to the physician
in showing him to excel in his art.

The signs belonging to the first category are called " demon-
strative " ; those of the second category are " commemorative " ;
those of the third are named " prognostic."

453. The signs of health, (i) Those which denote an
equable temperament. These are referred to in 494. (2) Those
which denote equability of the composite : (a) substantial :
creaturely form, position, quantity, number ; (F) accidental :.
comeliness, beauty ; (c) final : (i) that is, fulfilling functions ^
(ii) fulfilled function.

Every organ is healthy whose functions are adequately
performed.

257 S

258 THE CANON OF MEDICINE

The evidences that the functional state of the principal organs
is adequate is shown by, studying their activities. Thus the
state of the brain is shown by the state of the voluntary power
of movement, by the state of the sense-organs, by the acts of
judgment ; the state of the heart by pulse and respiration ; the
state -of the liver by the character of the excreta and urine.
(If the urine appear like the washings of fresh meat it shows that
there is deficient liver-function.)

454. The signs of disease. i Some signs are pathognomonic
of disease — thus : rapid pulse-rate, in fever, itself indicates
fever. 2 Other signs indicate the position of the disease. Thus
a hard pulse denotes diaphragmatic pleurisy ; undulant pulse
denotes inflammation ' in the substance of the lung. 3 Other
signs indicate the cause of the disease. For instance, the signs of
plethora, or of depraved states in their various forms.

4. Some symptoms are essential to the illness, as they begin
and end with it. (For instance, acute fever, piercing pain,
dyspnoea, cough and serrine pulse— essential to pleurisy.)
Other symptoms show no time-relation of this kind ; they some-
times coincide with the disease and sometimes not (e.g. headache
in fever). Other symptoms appear only towards the close of the
illness — as for instance, the symptoms of crisis, of maturation,
of delayed maturation ; the signs of death. These symptoms
are often associated rather with acute illnesses.

5. Other symptoms concern the state of the members.
Some of them are discernible by the special senses — colour,
hardness, softness, heat, cold, and the like. Others are dis-
cernible by all senses together — the form of the member, its
position (posture, attitude), its size, its movements, or stillness.
Some symptoms point to an interior state, as when tremor of the
lower lip reveals nausea. Changes in measure and number
reveal internal states ; for instance, shortness of fingers denotes
small liver.

' 6. Morbid states are discernible by the special senses. Thus
a black or yellow colour of the excrement reveals a morbid state.
Black or yellow jaundice of the whole body reveals an obstruction
in the biliary passages.

7. States manifested to the sense of hearing. — Eructations
reveal gastrectasis, and defective digestive power.

' 8. Odours and tastes also enable one to become cognisant
of morbid states.

9. Other visible evidences ; curved nails denote ulceration

THE CANON OF MEDICINE 259

in the bronchi, phthisis and " hectic." Redness of the cheek-
bones suggests inflammatory deposit in the lung.

455. 10. Movements (gestures, postures, attitudes'). — The
states of the body are revealed by its movements, or absence of
movement. (i) Motionlessness of the body as a whole — in
apoplexy,- epilepsy (coma), syncope, palsy. (2) Unusual move-
ments : shivering," tremor, twitching, sneezing, yawning,
stretching, cough, trembling, spasms (especially note in which
member this begins) ; (i) some of these are physiological
(hiccough) ; (ii) others are symptomatic (convulsion or spasm,
tremor) ; (iii) some are voluntary (tossing about in bed ; turning
from side to side) ; (iv) others are partly voluntary, partly involun-
tary (cough, micturition, defecation) ; in some of these the
voluntary is overruled by the involuntary (cough), while in others
the voluntary overrules the involuntary (micturition and defeca-
tion, occurring too slowly owing to interference by the will) ;
(v) involuntary movements. Some of these are evident to the
senses (e.g. shivering), others are not (e.g. quivering, jactitation).
These movements vary (a) in regard to their nature ; thus,
cough is intrinsically more energetic and powerful than quiver-
ing; (/?) in extent : thus, the act of sneezing entails the use of
more muscles than the act of coughing does ; coughing is
accomplished simply by the movements of the chest, sneezing
entails movements of the head as well as of the chest; (y) in
degree of associated mental anxiety. Dry hiccough is associated
with a greater degree of mental anxiety than the movement of
coughing, though the latter is more vigorous, being reinforced
by the natural faculty. In some cases the movement is aided by
an essential primary instrument ; thus, defecation is aided by the
abdominal muscles ; in other cases the aid is extraneous : thus,
the natural act of coughing may be aided by the atmosphere;
( s ) in origin. These movements vary (a) according to the member
(cough, nausea) ; (b) according to the faculties involved (jacti-
tation originates in the vegetative faculties ; the act of coughing
originates in the sensitive faculties) ; (c) according to the humour
concerned (thus, cough proceeds from an excretion ; twitching
from a gaseous agent).

These are all evidences of conditions in the members and
are chiefly external in character. Some of them reveal internal
conditions ; as, for instance, redness of the cheeks is a sign of
pulmonary inflammation.

There are also (internal) evidences of external conditions,
and to discern these a perfect anatomical knowledge is necessary.

2 6o THE CANON OF MEDICINE

456. One must have a proper knowledge of : —

(i) the essential structure of each member ; whether fleshy
or not ; what is its normal form. One must know (a) whether
the swelling for instance is according to the proper form of the
member or not; {b) whether it is proportioned or not; (c)
whether- it is possible for anything to be retained within the
given member or not; (d) whether that which is within (e.g.
jejunum) can escape; (<?) whether there can be retention in
and also' escape from the member ; (/ ) what the material is
which can be retained in it or discharged from it.

(ii) Its site. From this one judges whether pain or swelling
is actually in the part or at some distance from it.

(iii) Its relations. By this knowledge one judges whether
pain is arising per se or reflexly from the surroundings, or whether
the matter in an inflammatory mass arose in it or has entered
into it from neighbouring parts. If it be a " superfluity " which
escapes, is this the matter itself or is the affected member merely
the channel by which the matter finds egress from the body ?

(iv) How to decide whether the discharge could have come
from the supposedly affected member or not.

(v) The normal function of a member. — From inter-
ference with function one recognizes' the diseased state.

This is the purpose of the study of anatomy. And a knowledge
of anatomy is also necessary to enable the doctor to control
diseases involving the interior organs.

457. The study of the significance of the symptoms of
internal diseases should follow the following six headings :

i. Interference with function. The functions have already
been described in regard to their qualities and degrees. The
indications here are primary and constant.

2. The discharges. The indications here are constant but
not primary. They are constant in that they are always associated
with morbid states. They are not primary because they denote
maturation, or interference with maturation.

These are neither primary, nor
constant.

3 . Pain

4. Swelling
$ . Altered p osition
6. Special symptoms
458. Details about these headings.

1 . Interference with function. When a function does not
proceed normally, it shows that the agent at work is attacking the
faculty itself, and the loss of function is secondary to disease of

THE CANON OF MEDICINE 261

the organ subserving that function. There are three ways in
which function is interfered with : {a) impairment (e.g. failing
eyesight, near sight, digestion impaired in rate or degree) ; (b)
alteration (as when the eye sees that which is not there or per-
ceives incorrectly ; when the stomach digests food wrongly
and causes it to decompose) ; (c) destruction (as when there is
entire loss of vision; entire loss of digestive power).

2. Significance of discharges and retentions.

A. Retention of that which is normally discharged :
retention of urine or feces.

B. Abnormal discharge :

(i) From the substance of a member

(a) itself diagnostic : Ex. : when a piece of
cartilaginous tissue is coughed up ; this is a
proof of deep ulceration in the air-passages ;

(b) diagnostic by reason of its dimensions or
amount : passage of flakes in dysentery ; if
they are large flakes, the ulcer is in the large
intestine ; if fine fragments, the ulceration is
in the small intestine ;

(c) colour of the discharge. If urinary sediment
is red, it shows the disease is in the fleshy
organs such a.s the kidney ; if white it shows
the disease is in a muscular organ like the
bladder.

(ii) Not from the substance of a member :

{a) entirely unnatural. Thus healthy humours
or blood should not be discharged at all ;

(b) abnormal in quality. Thus depraved blood
may be discharged physiologically, or not ;

00 abnormal in quantity : e.g. polyuria, oliguria,

excess of fecal discharge, paucity of feces :

(a) abnormal in quality : black feces,

black urine ;
(/?) discharge by unsuitable or unnatural
channels : e.g. passage of feces by
the mouth in cases of strangulated
hernia.

3. Significance of pain.

{a) Its site : If right-sided, examine the liver ; if left-sided
the spleen. '

262 THE CANON OF MEDICINE

(b) Its type, which reveals its cause (see 434 ; ^ancLthe
doctrine of causes). Severe pain indicates inflammation in a
non-essential member, or in a member which has lost sensation,
but has become greatly, distended by foreign matter. Incisive
pain shows that the diseased material is sharp, acid or acrid.

4... Significance in regard to inflammations.

{a) As to essence : erysipelatous inflammation denotes
bilious humour; " scirrhus " (induration) denotes atrabilious
humour.

(b) As to position : whether on the right side or the left

(liver, or spleen).

(c) As to shape : a moon-shaped swelling in the right
hypochondrium points to the liver ; an elongated swelling
refers one to the overlying muscles (rectus and adnexa).

5. Significance of site and relations.

The site may be self-evident. The relations vary in sig-
nificance according to the morbific agent. Thus a lesion in
the fingers may result from injury to the brachial plexus in the

neck.

6. Significance of special symptoms : e.g. of wasting, of
black tongue, burning fever.

Joannitius gives a rather different classification of symptoms and signs,
though summarizing from the same text. It may be said that every classification
is a matter of personal convenience. There is not necessarily any principle involved,
for the subject comprises so great a variety that a strictly logical classification serves
no special purpose. In some cases symptoms are characteristic of a cause, m others
of an error of function, in others of a special disease. To adhere consistently to one
rule of classification necessarily entails the relegation of some symptoms which are
important in actual practice to a. subsidiary or insignificant position in the list.

Hence it may be said that Avicenna's classification will hold gcod as well as
any. The student obtains his knowledge from his own experience, and not from
memorizing a given list.

§ 202 . The following list of simple ailments, or evidences of disease, may
be offered at this point. 8 5 , . . .

Pain. — The first evidence of disease or ill-health. Its localization is very signi-
ficant, and charts depicting its possible sites and their meaning are of great use.
Thus,' headache is very commonly simply a sign of indigestion (gastric or intestinal)
or constipation. The type of pain is most important. Thus pain in the abdomen,
relieved by pressure, suggests gaseous distension due to abnormal fermentation of
food, whereas pain increased by pressure suggests inflammation.

Abnormal discharges. — Abnormal in quantity (increased or diminished), such
as diarrhoea, polyuria ; abnormal in quality, such as nose-bleeding, hemoptysis,
expectoration, nasal discharge, salivation ; abnormal in manner, such as incontinence.

Abnormal acts. — Vomiting, Coughing, Hiccough, Eructations, Yawning,
Sighing, Shivering, Sleepiness, Insomnia, Altered gait, Altered posture (from palsy,
exhaustion, collapse), Tremors, Twitchings, Convulsions, etc.

A bnormal subjective sensations. — In special senses : floating specks before the
eyes in dyspepsia ; ringing in the ears in cases of nervous debility, or after certain
drugs, or from wax ; bitter taste in dyspepsia ; dizziness arising from nerve derange-
ment,' or circulatory errors. In general : nausea, palpitation, throbbing, laboured
breathing ; altered appetite, thirst ; sense of lassitude or asthenia ; irritability ;
loss of memory. .

Outward signs. — Discoloured or " heavy " eyes. Offensive breath m indi-
gestion and constipation. Wasting or obesity. Hot and dry skin in fevers, or

THE CANON OF MEDICINE 263

states of mental excitement, or from excess of salt in the diet. Cold sweating from

exhaustion, etc. Altered colour of skin. CEdema of skin. Skin-eruptions. •

Signs derived from examination of the mouth : Pale tongue and gums from blood-
deficiency ; bleeding gums from excess of- salt in diet and other causes ; coloured
line on gums in metallic poisonings ; coated tongue in digestive disturbances ;
loosened teeth from errors of diet, or the use of adulterated foods, etc.

2. The Distinction between the Disease in itself and its

Secondary Effects

459. Diseases may affect a member primarily, or only
secondarily. Thus, a disease of the stomach may become associ-
ated with one in the head. Hence it is necessary to distinguish
between the two conditions, as being respectively primary and
secondary. To do this, note which arises first, and then note
which of the two morbid conditions persists. The former is
judged to be primary; the one which develops later is considered
to be secondary. Conversely, the disease is secondary which
comes after the first, and ceases when the first is relieved.

460. Errors may arise, however, because a primary disease
may escape the senses (being painless) at first, and its effect may
not become manifest till after the secondary disease has appeared.
Moreover the primary disease may not be able to be perceived
until after the secondary one has developed, and so one is liable
to regard the secondary one as primary, and overlook the real
root of the disease.

461. To guard against this mistake, the physician must
know the anatomical inter-relations of the organs, and also the
several affections which each member may show. Some of these
are evident to our senses, others are not. He must also avoid
giving a definite diagnosis of the root of the disease until he has
had time to consider the possibility of some of the states being
secondary or not.

462. Therefore the physician will diligently question the
patient in order to discover signs indicative of the various affec-"
tions which can possibly occur secondarily in the neighbouring
or related organs. If these are not painful (tender), the patient
is unaware of them, and the various signs and symptoms may be
only distantly related in his mind. He cannot know the relation
between remote symptoms and the real root of the disease. The
wisdom of the physician alone can determine this.

483. It is easier if one recalls the various points to memory
under the heading of hindrances to function. If these are prior
in time, the malady is secondary.

464. Some affections of organs are usually secondary to

2 6 4 THE CANON OF MEDICINE

others. Thus an affection of the head is usually secondary to
one or other of the morbid states of the stomach. The converse
is only very rarely true.

All the signs of the primary and secondary temperaments
will be set forth in a general way now, leaving the signs of each
special .organ to its appropriate place. The visible signs of a
composite disease are detected by the senses, but the internal
symptoms of the body as a whole cannot be described in a general
way except with difficulty— with the exception of the signs of
plethora, of obstructions in passages, of inflammatory masses,
and of loss of continuity. It is best to describe all these together
when we describe them under their specific organs.

3. The Diagnostic Signs of the Temperaments.

465. Signs from which the variety of the temperament is
discernible. — These can be arranged under ten groups.

I. the feel of the patient

By means of the touch one notes whether the feel of the
patient corresponds to health in temperate climes and temperate
atmosphere. If it corresponds, the temperament is equable.
If the physician is himself healthy in temperament and finds the
patient cold or hot, softer or harder or rougher than normal,
and this is not to be explained by the state of the atmosphere or
of a previous cold water bath, or some other contingency render-
ing the body soft or rough, though normal— he then knows the
finding is due to an intemperament.

466. The state of the finger-nails should be noticed.
Softness or dryness of the nails, not due to an extraneous agent,
informs one of the state of the temperament. These qualities
are not in themselves a sufficient criterion. There must be signs
of balance between heat and cold. For (a) heat, by its resolving
effect, would modify hardness and roughness of feel, and make
the patient seem to be attempered and his nature seem soft and
moist. Or, (b) cold — i.e. the opposite — by reason of the great
congelation and inspissation it induces, would make the softness
of feel in an attempered person seem hard, and give the im-
pression that his nature was dry. For instance, take snow and
the sun. Snow congeals and causes coagulation ; the sun causes
aggregation of particles. Many persons with a cold, tempera-
ment are soft to the feel, and also spare in habit owing to the
presence of much crudity in them.

THE CANON OF MEDICINE 265

II. THE STATE OF THE MUSCLES, FLESH AND FAT

467. Plentiful muscular development denotes moist tem-
perament, and warm temperament if the muscles are firm.
Scanty muscular development with very little fat shows that the
temperament is dry. Oiliness and fat always denote cold tem-
perament, and the muscles are then also flabby.

If at the same time there is constriction of the veins and lack
of blood, and if there is weakness from lack of food (because
there is too little blood to enable it to furnish the requirements
of the tissues), this shows that this temperament is inborn and
habitual. But if these other signs are absent, it shows the
temperament to be an acquired one.

488. Lessening of the amount of oil and fat in the sub-
cutaneous tissues always indicates a hot temperament, because
the substance of oil and fat is the oiliness of the blood, and that
is derived from cold. Hence these things are less plentiful in
the liver-region, and more plentiful over the intestines. There is
not more oil and fat over the heart than over the liver, except
as to matter ; it is not temperament or " form " which ac-
counts for this ; it is simply that the " nature " of the heart
depends for its maintenance on the presence of such-like
" matter."

Congelation of oil and fat over the body is greater or less
according as the heat is more or less in degree.

If the body is fleshy, and the amount of fat and oil not
great, the temperament is hot and moist.

If the body is very muscular, and there is much oil, but
little fat, this denotes excessively humid temperament. If ex-
tremely^ fleshy, this denotes superfluity of moisture and cold.
It is evidence that the body has become cold and moist.

469. The more spare the body is in habit, the more likely
is it to be cold and dry ; or (less likely) hot and dry ; or, dry,
for such a body is attempered as to heat and cold. Or, hot,
because such a body is attempered as to moisture and dryness.

III. THE HAIR

The points to note are : rate of growth ; amount ; fine-
ness or coarseness of texture, straightness or curliness, colour.

470. Rate of growth. Slow growth, or absence of growth,
without evidence of lack of blood — denotes extremely humid
temperament. More rapid growth denotes a. less humid tem-
perament, rather tending to dryness. (Heat and coldness of

266

THE CANON OF MEDICINE

temperament are shown by other signs — given above — than the
hair.) ;

If the temperament is both "hot and dry the hair grows much
more rapidly, and the individual hairs are numerous and coarse.
Abundance of hair means heat, coarseness much fumosity.
Hence the hair is more plentiful in youthful persons than at
puberty, as the humours of the latter are vaporose, not fumose.

The opposite characters denote the respective contraries.

471. Form of the hair. Curly hair : denotes hot and dry
temperament. It may be that there is tortuosity of the minute
channels and pores : and this cannot change even if the tempera-
ment changes. But the two primary causes would change if
the temperament changed. Straight hair denotes cold and moist
temperament.

472. Colour of the hair.

Colour

Black.

Brown.
Tawny and red.

Very fair.
Grey.

Corresponding
temperament.

Hot.

Cold.
Equable.

Cold and
very moist.
Cold and
very dry.

Remarks.

In such cases oxidative processes are in
excess of the mean (Joannitius).

There is an excess of " unburnt heat," so
that the hairs always grow red (J).
Hence the proneness to anger (a form of
" heat ").

Note how plants lose their dark or green
colour when dried, and become grey or
white. In man, this change is produced
towards the close of desiccant diseases.

473. Cause of grey hair. Aristotle stated that hair turns
grey because it takes on the colour of serous humour. (Joan-
nitius ascribed it to decomposition changes in the serous humour
occurring in old age ; greyness, he says, means excess of atra-
bilious humour.) Galen ascribed it to a mustiness accompanying
the nutriment supplied to the hair, which retards its movement
and penetration into the pores (of the hair) (i.e. hair-sac).

As a matter of fact there is little difference between the
two views, because the whiteness of the serous humour is
physically due to the same cause as the whiteness of the mustiness.
The subject really belongs to physics.

474. Observation also shows that atmosphere and geo-
graphical situation affects the hair. One would not expect to
find the hair red (which denotes equable temperament) in a

THE CANON OF MEDICINE

267

black person even though his temperament were equable ; nor
would one expect to find black hair (which denotes hot tempera-
ment) in a Slav, even though his temperament were hot.

475. Relation of character of the hair to the age. In puberty
the hair is as in northern countries ; in youth, as in southerly-
countries ; after the age of fifty it is between the two. Abund-
ance of the hair at puberty reveals the future temperament. As
the person grows, it precedes the formation of atrabilious humour,
and in the elderly person it shows that atrabilious humour is
actually present.

IV. THE COLOUR OF THE BODY

476. Colour.

Pallor.

Yellowish.

Ruddiness.

Sub-ruddiness.

Dark Brown.

Brown.

Colour of Egg-
plant fruit*
Chalky.

Leaden.

Grey and white.
Ivory White.

Temperament.

Cold.

Hot.

Extremely
cold.

Hot.

Cold and
dry.
Cold.

Cold and
moist.

Cold.
Cold.

Accompanying features.

Lack of blood.

Lack of blood ; increase of bilious humour.

Abundance of blood ; sanguine or bilious
temperament.

Dominance of bilious humour. Occasionally
it denotes lack of blood, provided there is
no bilious humour present in the blood,
as is the case in convalescents.

This is because sanguineous humour is
dominant, and there is deficient coagul-
ability of the blood and it darkens and
alters the colour of the skin at the same
time [Joannitius ascribed blackness to the
atrabilious humour].

The heat is such as follows upon pure atra-
bilious humour.

Serous humour in excess (J. ascribes white-
ness to the serous humour).

Atrabilious humour is only slightly in excess.
This is because there is a trace of green in
the whiteness ; the latter depends on the
serous humour and moistness of tempera-
ment. The greenness depends on con-
gelative change in the blood, for this tends
to a blackness which, mingled with serous
humour, produces a greenish tint.

Serous humour in excess, and the choleric
humour scanty.

477. Co/our of the eyes.

It is not easy, but it is possible, to assess the temperament
of the brain from the colour of the eyes.

* Egg-plant ; brinjall ; solanum melongena, or black brinjall. The colour
is a purple-black. The fruit is referred to as a colour in Night 357 : " a flabbv
nose like a bnnjall " (Burton). " The vegetable is held to be exceedingly heating
and thereby to breed melancholia and madness " (ib ).

268 THE CANON OF MEDICINE

The following details are from Joannitius :
Black : due to : smallness.. of crystalline lens ; setting of the

crystalline lens too far back ; ^abundance of aqueous humour ;

turbidity thereof; uvea redundant; peculiarity of the visible

" breath " (scanty, or confused).
Brown : due to the contraries of the above — crystalline lens large

or further forward ; paucity of albugineous humour ; clearness

of this ; deficient quality of uvea ; the visible breath plentiful

or clear.
Intermediate colours (black and brown mixed). The visible breath

varies in amount and clarity.
Grey : visible breath less plentiful.

478. Changes of Colour

Change to yellow (yellowish-white) : suspect disorder of
the liver.

Change to yellowish-black : suspect disorder of the spleen.

Change to yellowish-green : suspect piles (this does not
always hold good (marginal reading). These suggestions only
apply for the moment when the change of colour takes place.

479. Colour of the Tongue

It is not easy to assess the temperament of the stomach and
intestines and veins from the colour of the tongue, any more
than it is to assess the temperament of the brain from the colour
of the eyes.

There may be two different colours simultaneously in two
members, in consequence of a disease. Thus, the tongue may
become white and the countenance dusky. This occurs in
jaundice, when this is due to an intense acridity of the bilious
humour.

480. Extraneous causes of Colour Change

Cold climate (e.g. in Scotchmen), hot climate (e.g. negroes).
Emotional changes : fear, rage, sadness, etc.

V. THE FORM OF THE MEMBERS

481. Hot temperament : big broad chest ; large limbs ;
no narrowing or shortening of the hands or feet ; conspicuous
full veins.; big strong pulse ; the muscles round the joints large
(for growth and the form of composite structures requires heat).

Cold temperament : the contraries of aU the above. The
natural faculties and the formative faculty are impaired by cold,
so that the natural functions are not perfectly carried out.

THE CANON OF MEDICINE 2 6 9

Dry temperament : roughness, curvature of form ; joints
conspicuous. Adam's apple prominent. Nasal cartilages con-
spicuous ; nose of medium size.

Moist temperament : the contraries.

Joarmitius adds: fleshiness (excess of heat and moisture in the tem-
perament) •;■ Fatness (excess of moisture and intense coldness); Leanness (hot
temperament, and mtense dryness) ; Delicate build-cold and very dry • Massive

balan^d humours^ 7 m ° 1St ' ^ ^^ C ° ld ^ Very m ° iSt ; J ustness of form— well-
VI. RAPIDITY WITH WHICH MEMBERS RESPOND TO HEAT AND COLD

482. If a member becomes " hot " rapidly and easily,
it shows that it is hot in temperament, because change in the
direction of its own temperament is more readily undergone
than m the opposite direction. Similarly, if the member behaves
in the contrary way, it will be of cold temperament.

483. Some assert that it is otherwise, because we know
(they say) that a thing only reacts to its contrary and not to its
like. But if that were the case, it would follow that a thing would
react more strongly to its like. But the reply to this is that two
things are only really alike when one does not interact with the
other; we then know that their respective qualities are of like
" species " and " nature." Of two things A and B, if B is
less hot than A, we cannot speak of it as being " like A." As
long as one of the two is hotter, they cannot be called ""alike."
One is cold compared with the other. So an interaction (on the
part of the body) is possible. B would be cold compared with A
— not hot. B, too, may react with something else which is colder
than itself [say C] besides reacting with " cold " [say D]. C or
D may enhance the intrinsic quality of B, according as they are
stronger than B or not. It is easier for it to change towards that
which enhances this quality of B, or neutralizes the opposite
quality of B, on condition that the new causative agent harmonizes
with A and B, and neutralizes the temperamental nature (p).

Therefore it is clear that when the nature is of hot tempera-
ment heat will not show any action on it until the influence of
the contrary cold has first been removed ; and this is achieved
by preventing the calefaction (which tends to be produced by a
hot temperament) from becoming greater. The result is that
if both events occur simultaneously, and the inhibiting agent is
destroyed, they will mutually help one another in producing
heat, and the two qualities will thus reach an acme.

When the body is exposed to foreign heat, however, the
balance of temperament is likely to be destroyed. The innate

a 7 o THE CANON OF MEDICINE

heat of the body is all-important for resisting this We depend
on our innate heat for the neutralization of " hot_ poisons, and
for their expulsion and for the dissolution of their substance.

484 The innate heat, therefore, is the instrument ot
(human)'" nature " for combating the injurious action of extra-
neous or foreign heat. By its means, the breath gets rid of it,
expels it, disperses it, and oxidizes its material basis (m). further,
it combats the injurious action of foreign cold, expelling it
" by contrary." Coldness has not this power. It is only the
contrary to coldness— i.e. foreign heat— which can combat or
repress it. Coldness cannot combat extraneous cold. ine

innate; heat does.

485 Innate heat is that which protects the natural humours
from being overruled by foreign calorific agents. If the innate
heat is strong, the natural faculties are able to work through it
upon the humours, and so effect digestion and maturation, and
so maintain them within the confines of the healthy state. The
humours move according to its ministration. Extraneous or
foreign " heat " cannot interfere with this movement and so
they do not undergo putrefactive decomposition. If the innate
heat is feeble, the natural faculties are harassed m the regulation
of the humours. For the instrument— the intermediary between
the natural faculties and the humours— is enfeebled. Stagnation
sets in and foreign heat now finds the humours no longer opposed
to its action. It overcomes them. It utilizes them m its own
way, and imparts a foreign movement to them ; and the result
is what is known as " putrefaction." _ ,

486 Hence it is clear that the innate heat is the instrument
of all the faculties, whereas coldness can only help them second-
arily That is why one speaks of " innate heat, but not ot
" innate cold " ; and why that which is proportionate to heat
is not comparable with cold.

S 2 o3 This passage is evidently an attempt to explain the nature of bacterial

The following may be amplified accordingly .
i The meaning of innate heat.
2 The nature of " foreign heat, foreign cold.
■x The meaning of the term " hot poisons

a The meaning of hot and cold, as relative terms. .-,,,„

ti) JnnatThel^ This term, particularly m ^J^'^£"£^

<• -^\;L' Th^ word describes a complex concept. Though regarded as vague

known and freely-accepted data belong to it. material

(2) The nature of " foreign heat Joreigncoia. xuc =! ., substa nce

THE CANON OF MEDICINE 271

stance, which as we know undergoes lysis in the course of the immunising processes
of the body. The " heat " refers to what we know as the bacterial toxins which
act upon the thermogenic centres, and produce numerous other effects oh the
tissues. The word "heat" thus comprises two things. The pyrexia produced
by bacterial invasion may be theoretically distinguished from the innate heat, but
practically speaking the rise of temperature is generally admitted to be part of the
so-called defensive mechanism against infections. The destruction of the bacteria,
and of their products by anti-substances — these events are comprised in the words
" dispersing the foreign heat." After all, both bacteria and products are " dis-
persed." We are only being told the same fact in different language.

In the case of foreign cold, here the organisms and products differ. But if
the temperature becomes subnormal, the immunizing process is not ascribed to the
lowered temperature. Recovery from the infection still depends on the " innate
heat " or " vitality " — that is, a series of processes of immunization which take
place whether the patient develops fever or not.

Avicenna considers that the formation of septic products is more likely if there
is not much pyrexia, on the ground that in such a case the bacteria, as we should say,
meet with less resistance, and are enabled to produce those decompositions of the
body fluids which we know to take place readily as soon as the vitality of a part
is lowered.

(3) The meaning of the term " hot poisons." Clearly the word poison must be
understood as covering both bacterial agents and their products. The toxic products
may produce rise of temperature, and are therefore reasonably called " hot " ;
others do not have this effect.

(4) The meaning of hot and cold, as relative terms. In this passage a thing is
hot or cold according to its effect on the bodily sensations, or its effect on the heat
centres of the body. Taken in its literal or surface meaning, of hot temperature,
cold temperature, the passage is of course pedantic and useless. It should be evident
that the words " hot " and " cold " cannot possibly have meant literal heat and
cold.

VII. SIGNS DERIVED FROM SLEEP AND WAKEFULNESS

The sensitive faculties make use of these things frequently,
in a manner corresponding to the primary qualities. Thus we
say that in the wakeful state the body is the instrument of the
soul.

487. If there is equipoise between sleep and wakefulness,
it means that the temperament (especially of the brain) is equable.
If sleep dominates, it denotes a cold and moist temperament
(of the brain), whereas if wakefulness dominates, it shows a dry
and hot temperament (especially in the brain).

A strong inclination to sleep denotes debility — a loss of tone of the muscular
power. Histologically, sleep depends on a break in the ideation-zone of the cerebral
cortex ; if there is a break in the layer below that, the sleep will be that of stupor
or coma. The break in this situation is marked in amentia and dementia. — Wake-
fulness, or insomnia, denotes : poisons circulating in the blood, powerful sensory
impulses (pain), or powerful emotions.

VIII. SIGNS DERIVED FROM THE STATE OF THE FUNCTIONS*

488. Equable temperament : the activities of the body
proceed fully and perfectly and naturally.

Hot temperament : there is over-activity, exaggerated

* Functions may be weakened, exalted, depraved, obstructed in their action
or abolished.

272 THE CANON OF MEDICINE

activity. Rapid growth of stature ; increased rate of growth
of hair ; early eruption of the teeth.

Cold temperament : the activities lessen and become sluggish
and delayed, but a hot temperament may cause weak and sluggish
activity though only if a deviation from the natural course is
associated with weakness.

489. Many natural functions may slow down or lessen
owing to heat. Thus in the case of sleep, sometimes there is
insomnia or lack of sleep from the effect of the heat of a hot
temperament. Similarly some of the natural states may be
intensified by cold. Thus, again, in the case of sleep, though this
is not strictly the outcome of natural functions, but only an effect
conditional upon some causal agent. For the necessity for
sleep for life and health is not absolute ; (a) it enables the breath
to separate off from its impeding factors — the fatigue-substances;
(b) there is need for a recumbent posture after a meal ; (c) one
cannot achieve two (contrary) things at the same time. _ Hence
the need for sleep is simply some impotency. It is not included
in " natural necessity." And if its exclusion be " natural " in
the sense that it is inevitable, this is only because the word " natu-
ral " is here used for " the inevitable." One word is being made
stand for two things. But the most accurate application of the
term is to " equable temperament," for it is this upon which
equability of functions and their final completion depends.
To use the term in regard to the four qualities — heat, coldness,
dryness, moisture— is only hypothetical (takhminl).

490. Among the " strong " (" jelal ") actions which denote
a hot temperament are : powerful voice ; harsh or coarse
voice ; rapid way of talking ; constantly talking ; anger ;
rapid gestures ; blinking of the eyelids. Before deducing a
hot temperament from these, one must make sure there is no
local cause for them, and that they are not confined to one
particular member.

IX. SIGNS DERIVED FROM THE EXPULSIVE FACULTY AND FROM THE
QUALITY OF DISCHARGES

491. The temperament is hot : (i) if the waste matters
are retained ; (2) if the faeces, urine, sweat, etc., are strong in
odour, acrid, of normal colour, and show the normal degree of
oxidation and maceration — in the case of matters which normally
undergo such changes.

If the signs are contrary, the temperament is cold.

THE CANON OF MEDICINE

273

X. SIGNS DERIVED' FROM THE STATES OF THE MIND, DURING

ACTION AND PASSION

" Every expression is the sign of a state of mind ; that state is as the hand,
and the expression is the instrument." — (Mesnavi, 5S p. 29).

492. - • Evidence.

Name of Temperament corresponding.

Hot.

Dry.

Concupiscible 2

— (Shameless) *
Excitable
Lively
Vivacious

Infatuation ; love-
passion.

aspect

Irascible 2

Duration

Hopefulness
Courage ; temerity J
Easily provoked to

anger
Short

Brooding

Anger lasts some time

Long*

Intellectual power

Good

Imaginative

Mental
capacity

Power of observa-
tion

Good

—

Capability
Talent

Good
Conspicuous

Memory good

Moral aspects

Stern

Virility of morals and

manners
Diligence
Much flexibility of

opinionj

Gentle

Ego faculty

Love of good opinion
Not easily perturbed
or downcast

Takes things to heart

Movements and gestures

Rapid

Dreams

Of warming oneself at
a fire ; sitting in the
hot sunf

Cold temperaments show the opposites to those given for
hot temperaments ; moist, the opposites to those given for dry.

The whole of the above, or at any rate the major part of it,
refers to the congenital or innate temperament. Now we refer
to acquired temperaments (" intemperaments ").

* In the case of the moist temperament, the duration of emotional disturbance
is short.

f In the case of a cold temperament, the dreams are of being in the cold, out
in the snow, or of being immersed in cold water.

In short, the character of the visual images in the dream is related to the char-
acter of the dominant humour, partly because the dream varies with the state of the
" breath " at the time.

% These represent negative or weak aspects.

274

THE CANON OF MEDICINE

493. EVIDENCES OF THE

FOUR PRIMARY INTEMPERAMENTS

Evidence.

Hot.

-Cold.

Moist.*

Dry.

Morbid states to
which there is a
tendency

Inflammatory
conditions be-
coming febrile.

Loss of vigour.

Fevers related
to the serous
humour.

Rheumatism.

Lassitude.

Functional
Power

Deficient energy.

Deficient diges-
tive power.

Difficult
digestion.

—

Subjective
sensations.

Bitter taste in

mouth.
Excessive thirst.
Sense of burning

at cardiac orifice.

Lack of desire
for fluids.

Mucoid saliva-
tion.

Sleepiness.

/ Insomnia.
\ Wakefulness

Physical signs.

Pulse extremely
quick and fre-
quent ; approach-
ing the (weak)
type met with in
lassitude.

Flaccid joints.

Diarrhoea
Swollen
eyelids

Rough skin.
Spare habit

(acquired not

inborn) .

Foods and

Calefacients are
all harmful.

Infrigidants are
all harmful.

Moist articles
of diet are
harmful.

Dry regimen
harmful.

medicines.

Infrigidants
benefit.

Calefacients
benefit.

Humectants
benefit, f

Relation to
weather
(i.e., season).

Worse in summer.

Worse in winter.

Bad in autumn

4. The Evidences of Equable Temperament

(i.e., the evidences of symmetry, beauty of form, and good conformation.)

494. In addition to the signs of normal temperament
already given, there are :

1. To the feel, the body imparts sensations mean between
hotness, coldness, dryness, moisture, softness, hardness.

The skin feels moist and warm, and has a beautiful smooth and elastic surface.
The complexion is clear.

2. In colour, the body shows a balance between whiteness
and redness.

3. In build, the body is neither bulky nor spare, though
on the whole inclined to be bulky. (Robust Habit of Body. 7 )
Tallness and straightness of stature ; quick growth.

4. The veins of the skin are neither prominent nor sub-
merged ; they are separated and spread.

* The signs of moist intemperament include those of the cold.
f Hot water, rarefied oils are beneficial to the dry temperament and are
avidly taken up.

THE CANON OF MEDICINE 275.

5. The hair is neither profuse nor sparse, thick nor thin,
curly nor straight, black nor white. During puberty they tend
to a tawny shade rather than 'black, in youth they tend to black-
ness. [Full hair where hair should be.]

6. Equally inclined for sleep and for wakefulness.

Sleep quiet, uninterrupted, and followed, on waking, by cheerfulness, and a
contented mind.

7. Agreeable dreams arousing hopefulness, with fragrant
perfumes and alluring voices, visions and agreeable com-
panionship.

8. Mental faculties : vigour of imagination, intellectual
power, and memory. Emotions balanced between excess and
deficiency — e.g., between courage and timidity, between anger
and patience, between sternness and clemency, between vacilla-
tion and perseverance.

9. Perfection in all functions (185).

Therefore no conscious feeling of digestion, or discomfort of any kind.
Micturition painless, the urine not feeling hot, having an odour neither sweet nor
sour, amber-coloured, and forming no deposit. Defecation without soiling the skin,
the fasces firm, but not hard. — The appetite according to genuine hunger, and for
natural foods ; thirst only for water. — Mouth closed when breathing. Adaptability
to climate and to season (Ch. M.').

10. Movements of the limbs deft. (Skilful.)

495. A person with such a temperament will have a happy
expression, will be lovable and contented, moderate in desire
for food and drink, possessing a good gastric digestion, good
hepatic and venous digestion, and good alterative and assimila-
tive power all through the tissues. The waste matters will be
moderate in amount and will be -discharged through the proper
channels.

5. The Indications afforded by Congenital
Mal-conformation of the Body.

(i.e., asymmetry, misproportion, unshapeliness, ugliness, and the like.)

496. In brief, there is non-uniformity of temperament
among the members ; or, perchance, the principal members
depart from equability and come to be of contrary temperament,
one deviating towards one, another to its contrary. If the
components of the body are out of proportion, it is unfortunate
both for talent and reasoning power. Thus, (1) a tall person
with a large abdomen and short face and round head, and short
fingers' ; (2) a person of small stature, with small head, much
flesh in the face and forehead, and even in the neck and feet —
the face like the full-moon ; the jaws rounded and massive.

276 THE CANON OF MEDICINE

Similarly, (3). if the head and forehead were round, but the
face very round (long, marginal reading), and the neck very
thick, and if the eyes are sluggish in movement. Such persons
would be the very last of people to be classed as in good health.

6. The Signs of Plethora

497. Regarding plethora there are two aspects. There is
the plethora in regard to the cavities, tubes, and juice canals ;
and there is the plethora in regard to power or strength (vitality).

1 . Plethora of the channels of the body consists of an undue
amount of humours or of breath. These may be healthy in
quality, and merely superabundant in quantity, so that the
channels are overdistended and overfilled. In such a _ case
movements become dangerous, the vascular channels running a
risk- of rupture, followed by a flux towards the regions where
there is back-pressure, and choking of these parts may occur,
with subsequent apoplexy or epilepsy. To relieve such, the
local plethora must be rapidly relieved by venesection.

2. Plethora of strength of faculties. In this case the error
is not in quantity of humours, but in unhealthiness of quality,
whereby the faculties are embarrassed, and they become inefficient
for the processes of digestion and maturation. A person who
is in this state is in danger of putrefactive disorders.

498. Speaking in general the signs of plethora of the first

type are :

Objective : red face ; full veins ; tightness of skin ;
sluggish movements (gestures) ; full pulse. High-coloured
urine ; dense urine ; scanty appetite.

Subjective : sense of weight in the limbs ; weak vision ;
dreams in which there is a sense of weight — as when one dreams
one is unable to move, or is carrying a heavy weight, or cannot
give utterance to words. This kind of dream may be compared
with that associated with attenuation of humours, or where the
humours are moderate in amount for here one dreams one is
flying through the air, or moving at a great speed.

The modern term " hypertension" is covered by the old term of plethora or
repletion. The correspondence is verified by some of its symptoms. Thus, hemor-
rhagic phenomena occur — in the nose, retina, cerebrum, meninges, labyrinth, the
skin ; and as hematuria and hsemetemesis simulating organic disease. Hyper-
tension causes fatigue of the heart shown by : dyspnoea, palpitation, quick pulse,
anginal attacks, nocturnal pseudo-asthma, bruit de galop 141 (p. 348).

499, The signs of plethora in respect of faculties : Heaviness ;
sluggishness; loss of appetite (these are also present in the pre-
ceding type). Disinclination for exertion. Sense of burden-
someness.

THE CANON OF MEDICINE

277

If the plethora of. the faculty is unaccompanied by plethora
of humours, the veins are not as distended, and the skin is not
as tense, or the pulse as full and large, or the urine as gross
(dense) or as red in colour. There is no lassitude except after
undue movement and exercise and activity. The dreams consist
of sensations of itching, stinging, burning, and of fetid odours.
Which of the humours it is which is dominant in such cases
is discerned by the signs which now follow. But in the case of
plethora of faculty, illness ensues before all its signs are manifest.

7. The Evidences which show which of the Humours
500. is Dominant

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501. Additional remarks :

The age of the patient gives a clue to the kind of humour
likely to be dominant.

Excess of sanguineous humour is shown by signs akin to
those of plethora, and some of the signs given are accounted for
by simple plethora.

When the atrabilious humour is in excess, the blood is
dusky and heavier than normal. Atrabilious humour is seldom
in excess in pale and slight persons.

One or two of the data given (under general physique ; on the hair ; the sur-
face veins) are from Rhazes.

Note the patient at rest (in repose) and in activity (gestures, attitude
Note that the signs of his temperament are accentuated when he is ill. I lie
type of reaction to infection is determined by his temperament.

Signs of Obstruction (to the flow of the Humours)
502.

^M^^^S BSTRUCTION is known to be present if
%r,rm£l?^m^^ there are s jg ns indicative of accumulation
V of matters, and the patient experiences the
I" sensation of fullness throughout the body
-^ without there being any of the signs of
general plethora.

If the obstructions are in those channels
through which much fluid is bound to flow, there is
a feeling of weight or heaviness. Thus, in hepatic
obstructions, the material from the aliments cannot enter the
oro-an, and therefore accumulates and is retained, so as to
produce a much greater "encumbrance" than an inflammatory
swelling would. The difference from the latter consists in the
great heaviness and the absence of fever.

Obstructions in other channels do not lead to such a
sensation of heaviness, but only one of overfullness and of
stretching and tenseness.

503. Obstruction in venous channels causes the skin to
become tinged with yellow, since the blood does not then gain
access to the surface (layers of the skin).

The subject of " obstructions " is capable of great expansion.

(i) The symptoms differ : —

(a) With each of the humours. Thus, serous humour obstruction is manifested

THE CANON OF MEDICINE 2?9

as cedema of the glottis oedema of the lung, nasopharyngeal hypersecretion oedema
of the kidney tissue, of the blood itself ; vomiting, diarrhoea, headache (too much
cerebrospinal fluid), convulsions ; delirium, coma, Cheyne-Stokes respiration
amaurosis. ■ - r ■ >

(b) With the different substances. Thus in nephritis, obstruction of the
channels in the skin prevents the wastes leaving the body by that route, with conse-
quent manifestation as arthritis, anginas, otitis, etc.

(c) _ With the atom groups. Thus obstruction to the outlet of nitrogen
(azotaemia) manifests as hypertension, vomiting, diarrhoea, sialorrhcea stomatitis
parotitis, retinitis, anaemia, of plasmatic type ; arthralgia ; fibrillar tremors ; coma :
loss of appetite for meats.

Viewing diseases in this way, the important thing is to find both site of obstruc-
tion, and substance or atom-groups concerned.

(ii) The symptoms may be monosyndromic or polysyndromic (Vallerv-
Kadot, 1 " p. 296-299.) \ j

(iii) Obstruction to the flow of " breath."
x ^ ( iv ).J he "pores" which may become obstructed vary in size from that
of the orifices of the body down to the smallest channels, whether visible to the
naked eye or only with the microscope, or whether sub-microscopic or " ultra-
microscopic. The pores vary in shape and consistence, resilience, elasticity dis-
tensibility. Fluids may traverse them in both directions, but when there is ob-
struction, they may be able to pass only in one direction or not at all.

9. The Signs of Gaseous Distension
504. _ Gaseous distension is recognized (1) by means of
pain experienced in the sentient members. This is because the
gasos produce a severance of continuity in the tissue-elements ;

(2) by the movements which take place in the sentient members •

(3) by sound ; (4) by touch.

1. The pain of stretching is a sign of gaseous distension,
especially if the painful tissues are soft to the touch. The evi-
dence will be complete if the pain afterwards- ceases, for this
could not occur without there being a loss of continuity. In
members^ like bone or glandular tissues, gaseous distension is
not manifested by pain, even if such distension arises in
bones which have been fractured (unless the skin has been torn
by the fractured ends).

2. The movements which point to gaseous distension are :
fidgeting, tossing about (peristalsis). They are produced by the
gaseous materials making their way through the organs out of
the body.

3. Noises may be produced, e.g., gurglings, rumblings.
These may be evoked by manual compression, percussing — as
is done for distinguishing between dropsy (ascites) and tym-
panites.

4. Touch enables one to distinguish between distension
with gas and other nodular swellings. Gaseous distension
stretches the part and yields to pressure. That is not the case
with fluid distension (liquid, viscous, mucoid).

^ 505, The difference between inflation and gaseous dis-
tension is not in substance but in form. The form or shape,

2 8o THE CANON OF MEDICINE

of the distended area is different when standing or lying down
and manipulation will alter its position.

10.

The Evidences of Solid Swellings

506 The presence of external tumours is easily demon-
strated "to the sense of sight. Deeply placed inflammatory
swellings are revealed by accompanying fever, as well as by a sense
of heaviness, if the affected member be devoid of sensation, or of
stabbing pain as well as heaviness if the member be sentient.
Interference or hindrance to function and movement of a part
affords a further sign of the presence of a " tumour." A certain
degree of intumescence of the overlying part is a very important
sign of an inflammatory mass, if sensation has access to it.

Cold swellings are not accompanied by pain.

507 It is difficult to describe the signs of tumours in a
general manner. Even if one could do so it would be at the
expense of wearisome words. That is why it is simpler to defer
details to the special chapters. It will suffice for the present to
say that wherever heaviness and not pam are perceived, and the
signs of dominance of the serous humour are present, this leaves
no doubt about the swelling being of pituitous nature.

If there are signs of dominance of the atrabilious humour,
and the swelling is hard to the touch, it will be an atrabilious mass,
because induration is pre-eminent among the signs of this form

of swelling. .

508 Inflammatory swellings in muscular organs are
extremely painful, and fever is intense ; the nerves are stretched
early (causing the pain) and there is delirium. Such swellings
interfere with the movements of contraction and expansion.

509 Swellings in any of the inward parts of the body
cause the abdominal wall to become wasted. If they are in-
flammatory and undergo suppuration and track outwards, they
cause extremely severe pain, with fever ; the tongue becomes
very rough, and there is great wakefulness, and the symptoms
become more and more severe— notably the sense of heaviness and
weight and stiffness in the affected part. Induration and tension
becSme evident. Sudden emaciation of the body, with hollow-
ness of the eyes may develop. But when the process of sup-
puration has attained maturity, fever is high, pam lessens, the
pulse softens, throbbing subsides, and itching replaces the pam.
If there was much redness and induration, the redness lessens,
and the induration is less noticeable. Pressure on neighbouring
organs lessens, and all the causes of pain subside, along with

THE CANON OF MEDICINE 281

the great sense of heaviness. When finally the abscess bursts
there is a rigor (produced by the acridity of the sanious matter) ;
fever increases again (because of the movement and discharge
of the pus), and the pulse becomes " empty," unequal, weak,
infrequent, small, broad, and slow. There is loss of appetite ;
often the extremities grow warm.

The pus may also be discharged through ordinary routes —
the expectoration, the vomit, the urine, or the fasces.

510. The following signs after the bursting of an abscess
are good : subsiding fever, easy breathing, return of strength,
quick evacuation of pus through its proper channels.

511. Sometimes, however, in deep abscesses, pus passes
from one member to another ; and this transference is sometimes
beneficial, sometimes detrimental. It is beneficial when it passes
from a principal member to a subordinate one ; as for instance,
when it passes from the brain to the tissues behind the ears, and
from the liver to the groins. It is detrimental if it passes from
an ignoble organ to a noble one, or to a weaker or less resistant
organ, as for instance when pleurisy involves the heart or
lung.

512. The passage of latent or hidden inflammation and
abscesses and eruptions to higher or lower regions affords (dis-
tinctive) signs. If they pass downwards, this is shown by difficult
breathing and other respiratory trouble, and tightness of the
chest. There is a burning sensation beginning below and passing
to the upper parts. There is heaviness in the region of the
clavicle ; and headache. Evidence may also be obtained from
the clavicle and forearm.

If it should pass upwards, and the brain become involved
in inflammation, it is a bad and very grave sign. But if the
inflammation passes into the loose tissues behind the ears, there
is hope of recovery.

Epistaxis is a good sign in such a case, as it is in all inflam-
mations of the internal organs.

A more careful account of all kinds of swelling will follow
later, at the same time as we deal with the morbid states of the
several internal organs.

11. The Evidences of Loss of Continuity

513. Loss of continuity in a visible member is readily
evident to the senses. In the case of interior organs, loss of
continuity is shown by

282

THE CANON OF MEDICINE

(i) Pain — boring, stabbing, tearing.

(2) Especially if there is no fever.

(3) Often there is the flow of some humour — such as [a)
hemoptysis ; (b) effusion into a roomy cavity of the body ;
(c) outburst of purulent matter : in the cases where loss of con-
tinuity-follows the maturation of an abscess, with bursting of
the abscess. If the suppurative process has matured, the fever
will subside and the pus be discharged, and the sensation of
heaviness and pain will subside. Otherwise the pain would in-
crease, and the other symptoms become more severe.

(4) In some cases, loss of continuity is revealed by complete
luxation of the member, or partial displacement from its proper
position (e.g. hernia). . ,

(c) Diversion of discharges from normal to other channels,
or into some cavitv, which has itself been produced by the break
of continuity. Ex. : traumatic rupture of the intestines, whereby
the fecal contents cease to leave the body; (false aneurysm).

(6) In some cases, the existence of loss of continuity escapes
detection by these general signs. Special signs peculiar to each
member must then be utilized ; such as : loss of sensation;
inability to retain the fluids normally entering the part; rigid or
fixed position resulting from displacement of the part fromits
proper position ; lack of rigidity ; inability to retain relation
to another member from which it has become displaced. _ _

514 Prognosis. As you are aware, both loss of continuity
and the "presence of (inflammatory swellings) are more grave
when thev occur in very sensitive fibromuscular members.
In fact, such loss of continuity may prove fatal from syncope
or spasm. The syncope is due to the violence of the pain ;
the spasms are due to the irritation of the nerves in which the

parts are so rich. . . .

Next in severity comes loss of continuity near joints,
because restoration can only be slow considering the undue
mobility of the parts, and the fact that spaces are opened up in
and round the joints, and matters readily flow into these spaces.

We now proceed to expound the subjects of the Pulse and
the Urine, as affording general evidence of morbid states.

THE PULSE

"It is necessary to enquire diligently into the properties of the pulse for
diagnosis and for the use of drugs." — Duhalde. 20

" Every important variety of pulse revealed by the sphygmograph was re-
cognized, described, and named, before the Christian era. ... We count the beats,
and note their force and volume to ascertain the strength of the sufferer and the
effect upon him of the disease. . . . Many of the indications obtained from the pulse
do not depend on a knowledge of the circulation at all."* Broadbent, ".The Pulse "
1890, p. 32.

515.^ Definition. The pulse is a movement in the heart
and arteries (the receptacles of the breath) which takes the form
of alternate expansion and contraction, whereby the breath
becomes subjected to the influence of the air inspired.

In modern language, "it is the change of shape from the
flattened condition impressed on the vessel by the finger which the
artery assumes under the distending force of the blood within it,
which constitutes for us the pulse." (Broadbent, ib. p. 20.)

The subject of the pulse may be considered (i) generally,
(ii) in regard to each of the several diseases. We defer the latter
till abater period when we speak of the diseases themselves.
At this stage we discuss the subject generally.

516. Description. — Every beat of the pulse comprises
two movements and two pauses. Thus,

expansion : pause : contraction : pause.

One movement could not pass at once into another in an
opposite direction. There must be a boundary or " limit of an
act," as is expounded in the work on natural science.

Many doctors consider that it is impossible to perceive the
movement of contraction. Others are able to perceive it — as
" strength " — if the pulse is strong ; as " degree of expansion "
in a large pulse, as " great resistance " in a hard pulse, and, in a
slow pulse, by the long period of time occupied by the movement.

Galen also says : " For many years I was doubtful about
clearly discerning the movement of contraction by touch, and I
shelved, the question until such time as I should learn enough to
fill the gap in my knowledge. After that, the doors of the pulse

* The following section on Sphygmology is therefore not obsolete, but of real
value to the modern practitioner.

283

2 8 4 THE CANON OF MEDICINE

were opened to me. Whoever should study these things as I
did will perceive that which I perceived [as it were, a brilliant
light shining suddenly out from behind total darkness. Whoever
allows these words to be true and not fabulous will benefit very
greatly ; despair will not touch him or frighten him from the
pursuit of his study, even though he makes no progress for
many years."] Nevertheless there are conditions in which this
movement cannot be perceived. .

517. Reason for feeling the pulse at the wrist. (i) it is
readily accessible ; there is little flesh over it ; (2) the patient is
not distressed by exposing this part.

§ 204. This reason is important in the East where the doctor
may not expose a female patient in any way. This interdiction
accounts for the extraordinary erudition attained in the art of feeling
the pulse, for instance in China. " The old Chinese doctors are
remarkably good diagnosticians. Although the study of the patient
is restricted to the examination of the two radial pulses, and noting
the state of the eyes and tongue, the diagnosis is disconcertingly
accurate." (Hartmann. 28 ) [(

William of Rubruk, a Franciscan friar (1253) recorded : ihe
Cathayans ... are first-rate artists in every kind, and their phy-
sicians have a thorough knowledge of the virtues of herbs, and an
admirable skill in diagnosis by the pulse " (quoted in Encycl. Brit.,
vi. 189, by Prof. Giles, who also states " the variations of the pulse
have been classified and allocated with a minuteness hardly credible

P ' 2 Eusebius Renaudot 148 (p. 209), in 1733, wrote : " They are so
sure of the disease that they tell all the precedent symptoms to a
nicety."

(3) The artery runs in a straight course (which is no small
help towards accuracy of diagnosis : Galen).

(4) The distance from the heart is not great.

§ 205 The heart and arteries all pulsate with the same rhythm,
so that any artery can be used for feeling the pulse. But most arteries
are embedded in flesh and cannot be distinctly felt. The order of
clearness is : wrist, soles, behind ears, along arms.

Arteries within bones cannot, of course be felt ; nor can arteries
be made use of which have other bodies in front of them except m
emaciated persons, where for instance the aorta or limb arteries
become palpable for the first time.

518. Technique in feeling the -pulse. (1) The position of the hand.
If the palm be turned upwards the pulse will appear wider, less
high and less long, especially in thin persons. If the hand be
oalm down, the pulse seems higher, longer and narrower.

THE CANON OF MEDICINE 285

§ 206. (2) If the patient be a male, use the left hand : if a
female, the right. 93 This ancient Chinese idea, that the pulse of
one side has a different significance-to that of the other, is also met
with, in a different form, in recent literature. Thus, Tones (see Bibl.)
states that the pulse at the right wrist informs of the state of the con-
stitution, or vitality, and that of the left wrist informs of the local
disease, and the real and true condition of the patient. He further
states that when both pulses are fully strong and regular, after an ill-
ness, the patient is nearly well.— Baraduc, 110 on the basis of biometric
observations of an elaborate kind, asserts that reactions obtained
with the right hand belong to changes in the physical or material
vitality of the body, whereas those obtained with the left hand belong
to the psychic vitality.— These statements are of interest in relation
to the ancient Chinese idea.

(3) The position of the observer's hand.— This must be adapted
according to the position of the patient. The middle finger must be-
placed exactly at the junction of carpus with lower end of radius..
The other two fingers are now allowed to rest upon the artery, one
on either side (ib.). The index finger should be nearest the heart..
(Broadbent, p. 39.)

(4) Emotional state of the patient. The pulse should be felt
at a time when the patient is not in a state of excitement or anger,
or affected by exertion, or under the influence of the emotions,
or in a state of satiety (which renders the pulse heavy), or of
hunger ; nor must it be a time when usual habits are neglected
or new ones are being formed.

§ 2 °7- (5) The state of the observer. The observer must be in a
calm state of mind. He must be very attentive and free from the
least distraction of thought. The body must be tranquil, and the
posture at ease. The respirations should thus be unimpeded and
regular. His own state of health should be good (Duhalde. 20 ).

Comparison with a normal pulse is thus possible.

§ 208. (6) Other instructions given in the Chinese system of Sphyemoloey
The instructions for feeling the pulse include the following : first apply the
fingers gently, touching the skin very lightly at the three places corresponding to
the three fingers— named C (for cubitus, or lower end of radius), G for " gate "and
W (for wrist), the successive fingerpulps being in contact with those three places
J. he character of the pulse is now noted in reference to the vital organs.

s ! .M. Th f next ~ ep is to apply the fin g ers a little harder, but not hard enough to
feel the bone. The attention should now be directed to the state of the pulse at G
J. he third step consists m applying pressure till the bone can be felt, and then making
tests with a view to deciding on the. state of each of the five main organs &

If the wrist be long, the fingers need not be readjusted ; but if short readjust-
ment of the fingers must be made several times, moving to juxtapositions each time

J- he attention must not be allowed to wander from the search in question—
the five vital organs and the six viscera. The sensation imparted to each finger is
noted for the purpose. Great exactitude must be observed. The observation
will evidently occupy a considerable period of time.

" Fine though these distinctions are, the sedulous physician will perceive
and remember them."

A copy of one of the numerous diagrams in the work quoted is here appended
substituting a translation for the actual accompanying text.*

* For guidance in the translation of this passage and many parts of the work
quoted, grateful thanks may be here expressed to Prof. J. P. Bruce and Mr. Li.

286

THE CANON OF MEDICINE

^^Mj$r

err; *|iie -hr*

( Superficial pressure, to learn state from
1 loin to ankle.

*-Deep pressure : from heart to head.
f Superficial : stomach, oesophagus.
\Deep : spleen.
( Superficial : chest.
\ Deep : lungs to head.

The left side is studied with reference
to the state of the heart, small intestine,
liver, bile, kidney.

The right side, with reference to the
lung, large intestine, spleen, stomach,
generative system.

1 Wrist : heart, small intestine.
T ,, Gate : liver, bile.
lJiit \ Cubit: (medium pressure) : kidney
^ and bladder.
I Wrist : lung, large intestine.
_. ,. Gate : spleen, stomach. _

Rl 6 ht \ Cubit : heart and three vital
^ centres.
This is the classical and authoritative
statement.

The following conditions are emphasized in this Chart : (i) It is
summer : (2) the time-factor (including time of day) is 5, " j (3) J" 1 1S
excessive at Ch'uan, small on the right side ; (4) Yang is small on the lelt

W
H

a
o

d
a;
W

side. The pulse corresponding to this is at the right " cubit " : full or
heavy; fine or small ; and it is not responsive (to the " ether "). Another
time-factor is 9, 5, 9, 11.

K
H

" Q
tn H

H H

Pa
O

H
.J

THE CANON OF MEDICINE

§ 209. Some noteworthy theoretical considerations arising out
of the Chinese work may be added as applicable to the Arabian
conceptions, without attempting to" outline their full system.

We must study the subtler aspects of the nature of the human
being by invading the domain of " occult " science (by some con-
sidered to be forbidden), if we are to understand the real position not
only of the great Chinese work, but also that of the Canon itself.
With such a key, many of the passages acquire an entirely new aspect
and value. The expansion and retraction of " the breath "• — so
important in regard to the subject of the nature of the pulse, respira-
tion and other periodic movements — are part and parcel with
diurnal and other changes in what is called the " cosmic ether."
By working out the formulae embodying' the behaviour of the human
vibrations, using biometric methods, Baraduc 110 makes concrete that
which is usually passed over as unauthenticated and apocryphal.

The interpretation of the pulse depends on the interpretation of
the body itself. The latter follows " world-conception " rather than
concrete anatomy. The natural phenomena of the patient harmonize
with those of nature in general, and the two must be taken con-
jointly.

According to the classical style — ■" the two ideas — ' urge,'
' change ' — how important they are ! " They provide the key to
physiological processes, and also to the understanding of the pulse.
They represent something deeper than our modern idea " forces of
Nature " ; they are over and above the ordinary course of Nature, as
expressed in the Latin " praeternaturalis." These two ideas provide
the purpose of study as the physician sits with his hand on the pulse,
and his mind stilled for no small period of time.* The relation between
the root factors of life and those of the patient is to be elucidated ;
and they' find their expression in terms of functional activity of the
several organs of the body. Hence this science of sphygmology pays
regard to the seasonal variations, the age, the sex, the personal
constitution, the dominant ' element,' its phase (rise or fall\ and
especially the character of the vital force— active, passive, negative,
positive (see Figure). It aims at forming an opinion as to whether
the illness is slight or deep-seated, easily curable or incurable, fatal
or not, and if fatal in how long a time.

The permutations and combinations — the five tsang pulses,
the six fu pulses, the seven pyau pulses, the eight li pulses and the
nine tau pulses — all these afford ample scope towards a system which
may encounter ridicule but is too rich in minutia; to be lightly put
aside.

For, quoting Broadbent again : " It is impossible to examine
with attention a large number of pulses, whether among the healthy
or the sick, without being struck by the extraordinary diversity of
frequency, size, character, tension, and . force met with. This
diversity prevails quite independently of disease in both sexes and
with all ages, especially in regard to diameter of vessel and tension

* See Frontispiece.

2 88 THE CANON OF MEDICINE

and force of pulse. . . . Taking everything into account, there must,
when we compare the small, short compressible pulse of one man with
the large, firm and long pulse -of another be great differences in the
velocity and energv of the movement of blood through the capillaries
in different individuals, and clearly there are great differences in the
circulation of the same person at different times. . . . The fact that
such differences are compatible with health and vigour is conclusive
evidence that nutrition and functional efficiency, even of the nerve-
centres, are not in such close relation with and intimate dependence
upon the blood-supply as we are sometimes apt to suppose."

The endless diversity in the pulse is not an incident, it is funda-
mental ; the ancients sought to reduce it to a science because they
frightlv) believed there was a law underlying this diversity. This
goes with the fact that the various organs of the body actually vary
greatly from the standards adopted by the pathological anatomist.
The amount of blood discharged from the heart at each beat is very
different in various persons. The state of health is as it were some-
thing over and above the ordinary physiological mechanisms so fully
expounded in modern textbooks. The attempt to reduce nutrition to
mechanical laws is an attempt to bind to mechanics that which is
beyond mechanics.

Hence the studv of the Chinese system, and of their_ world-
conception affords additional justification not only for contending that
corporeal form, corporeal phenomena, and mental phenomena-
features, contours, build, mannerisms, talents— all belong together and
are mutually illuminative, but also for proceeding to the formulation
of these associations and inter-relations.

If in so doing, a Medicine is built up in which disease takes a very
minor place, and " soil " (a rather tiresome, though expressive word)
a first place, which it is the object of the physician to elucidate and
continuously realize, It will at least be a guide to something approach-
ing universality of application, and cease to attempt multi-specific
therapy.

S 210 The idea that different sensations can be imparted to adjoining fingers
by one and the same pulse may be discussed briefly here. It must be assumed
that there are potential waves of different lengths passing along the artery at the
same time. Long waves reach one finger, but not another. The long sweep of an
artery can actually be seen in thin subjects. The waves usually thought of are the
short ones induced by the force of the impacts of the heart wall on the blood. Long
tos consist of changes of tension in a spiral direction, and careful concentrative
observation will allow such an accession to be felt _ . ,

S 2ii The relation between pulse and special organs is not to be regarded as
fanciful when one obvious instance alone will justify it— the influence upon cardiac
activity' and force of beat which the state of the stomach exerts _

8 212 The frequency of missed beats, and the number of misses compared
with number of respirations, exemplifies another very widely neglected aspect of

8*2 1^ The names given to pulses are of interest, but it is difficult to assign
Chinese terms to particular Arabic or Latin names. It will suffice to present the
following comparisons of pulse-types with natural objects, and human, actions

Natural objects : Blade of small onion, solid within ; stone bullet shot out of a
crossbow; drop of water ; down; drum-head; grate in a passage ; hole in a flute;
filament of hair ; scattered leaves ; a pestle ; pills ; a silk thread ; the handle
of a staff or spear ; untwisted string ; worn-out cloth.

Table or Terminology

A.^ — General Terms.
(Arranged in pairs of opposites.)

Sec-

ft .

o °
O

tion

trans.

"(i)

521

522

(2)

523

(3)

524

(4)

525

(5)
(6)
(7)

526
527
528

(?)

529

(9)

(10)

530
533

Term used.

Long-Short

Broad-Slender

Deep-Elevated

Large-Small

Thick-Slender

Strong-Weak

Swift-Slow
(Rapid-Sluggish)
Hard-Soft
(Compressible-
Incompressible)
Full-Empty
Hot-Cold

Hurried-Infrequent
Brisk-Sluggish
" Dense "-" Rare "
Equal-Unequal
(Regular-Irregular)
Orderly-Disorderly
Rhythmic-

Arhythmic

Term in Latin
Text.

Longus-Curtus

Latus-Strictus

Profundus-Elevatus

Magnus-Parvus

Grossus-Subtilis

Fortis-Debilis

Vehemens*-Imbecillus

Validus*-Languidu.s

Velox-Tardus

Durus-Mollis
Lenis*

Plenus- Vacuus

Calidus-frigidus

Frequens-Rarus

Continens-Resolutus

Spissus f-Lassus

Aequalis-Biversus

Ordinatus-Inordinatus
Pondus-arrythmus

Term in Bulaq
Text.

Tawil'-qaslr*

' arid "-day yiq'

munkhaff ad 5 -mushrif •

'azlm'-saghir 8

ghaliz s -daqiq 10

qawi'^-da'if 13

sari' 1 '-bati' 1 *
salb ' '-layyin x «

mumtali' ' '-khali 1 •
harr^-barid 30
mutawatir * J -mutaf awut * '
mutadarik • '-mutakhalkhil * *
mutakaflif * 5 -mutarakhi * •§
mustawi * '-ikhtilaf a *
(mukhtaf)
Muntazim "-mukhtalif so
Wazn-arda'1-wazn s 1

Term in
Chinese Text.}

ch'ang-tuan

ch'eng-fu
ta-hsiao

li-jao
hung

k'uai-ch'ih

shih-juan
(Ke)

man-kung (hsti)

chieh(?)-huan(?)

mi (chin)-san
jun-k'ou

ting-tai

* Synonymous words occurring in older Latin editions.

§ These synonyms all appear together in the one (Bulaq) text.

t In the Latin the term " spissus " is often used as the opposite of " rarus.
In the Arabic, the latter is mutafawut, to which mutawatir is opposite. In the
passages in which spissus is used, the Arabic is often mutawatir and not mutakaSif.
There is actually a slight difference between frequens and sdissus, for the former
has the thought of an abrupt rise in the pulse-beat, according to group-number 2,
whereas spissus conveys the idea of beats very close together. Rarus may be taken
as the counterpart of either thought : if it means a leisurely rise, it is in accordance
with group-number 3 ; if it means " spaced," this is also the idea m mutafawut.
The Arabic distinguishes the two ideas of rarus, by using mutarakhi for sluggishness.

The words rapid, hurried, brisk— slow, sluggish, leisurely, rare, and the words
frequens, spissus, velox— rarus, tardus, languidus, are apt to be misleading, and it
is difficult to avoid inconsistency, both in the Latin and the English, for m some
cases one word conveys a better idea of a shade of- meaning, and in others another,
whichever Arabic term is employed.

'B. — Distinctive Terms.
(Arranged alphabetically.)

Term used-

Section

trans.

Bounding

Chord-like

Continuous

Creeping

Dicrotic

Failing

Flickering

h Formicant
i Harsh

540, 571
549
538

541, 572

546, 560

547, 568

545

k
i

m
n
o

P
1

Intermittent

Jerking

Mouse-tail

Recurrent
Spasmodic
Swooning

Thrilling
Wiry

Synonym.

Undulatory

Unbroken
Vermicular

Fading, falling

Recurrent

Term in
Latin Text.

Term in
Bulaq Text.

542, 572

543, 565

538
539

544, 567

538
548, 569
567, 600

548, 570

1548

Serrate,

sawing
Interrupted
Gazelle
Decurtate

Tense
Recurrent

mouse-tail
Trembling
Twisted

Undosus, fluctuosus
Chordosus
Continuus
Vermicularis
Bispulsans ; dicrotus
Cadens in medio

Reciprocus ; mesalius
pulsus inclinatus
(Rhazes)
pulsus innuens (Haly

Abbas)
Formicans
Serrinus, serratus

Intersectus

Dorcadissans ; gazellans
Cauda soricina ; murus

innuens
Reditivus
Spasmosus
Cauda reditiva
Syncopizans
Tremulus
Retortus

Al mawja* 18
Mutawattir 35
Muttasil"
Aldudi 3 '
Dzuwa qar'aina'
Al waqi' fi'l-

wasat 37
Musalli"§

Al namli"
Minshariy 10

Munqata' - '
Al ghazali 13
Zanabul'l far' 3

'aid 11

Mutashannuj 4 5
Ghashiya 16 .

Hung (?)
Hsien

Wei

Term in

Chinese

Text.J

Murta'ish"
Multawi 18

Chan Hsieh

Ts'u

Chin

Fu, jao, tai (?)

Tung (?)
Hsi

* Lit. a fast-going she-camel, whose girth slips through the inequality of the
motion of the fore and hind feet.

§ Lit. the third horse in a race.

J Some of the Chinese equivalents here gi
others are only approximately correct. This
sphygmology is different, as indicated in §209.
prove to be more exactly representative of the
It is of interest that the " water-hammer pulse :
(tan she, or yen tau), but does not appear to be 7

given are free of ambiguity, whereas

is because the basis of Chinese

Dual terms also exist which may

types given in part B of the Table.

e " is described in the Chinese work

: represented in the Qanun.

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To face />age 289

THE CANON OF MEDICINE 289

Actions seen in nature : .a bird pecking; a bubbling spring; the branches
of a willow tree in a gentle zephyr in spring ; drops of water dripping through a
crack in the roof ; frisking fish ; f eathers ; agitated by the wind ; a bird flying low ;
liquid being constantly gulped down ; rolling of thunder ; scattered leaves ;
swimming on the surface of water ; the pace of a toad embarrassed by weeds ; water
simmering in a kettle over a fire ; waves running into one another.

Human actions : Throwing earth over an object ; going by stealth ; the
strokes of a knife-point ; a knife scraping bamboo ; puffing and blowing in going
upstairs ; turning back.

§ 214. Ayurvedic Sphygmology . — Sarangadhara gives eight or nine verses
showing how to examine the pulse, and gives the characteristics belonging to derange-
ments of Vayu, Pitta and Kapha singly or in combinations. But this interesting
subject is necessarily not dealt with here.

519. Ten features in the pulse. We say that there are ten
features in the pulse from which we are able to discern the
states of the body. Some group them under only nine headings.

(1) Amount of diastole ; estimated in terms of length,
breadth, and thickness.

(2) Quality of impact (lit. knocking at) imparted to the
finger of the observer at each beat.

(3) Duration of time occupied in each movement.

(4) Consistence of the artery (resistance to the touch).

(5) Emptiness or fullness of the vessel between the beats
(modern : compressibility).

(6) The feel — whether hot or cold.

The remaining features concern several beats :

(7) Duration of time occupied by the pauses.

(8) Equality or inequality of force in successive beats.

(9) Regularity or irregularity ; orderliness or disorderliness.
Presence of intermissions.

(10) Metre ; rhythm ; harmony ;' measure ; accent.

§ 215. Additional points : frequency, or number of beats per minute ; number
of beats to each respiratory movement (inspiration plus expiration ; mode of rise,
mode of fall, and kind of pause at C.G. and W. as one tests from skin to bone and
back ; the number of beats which occur before there is an intermission (an inter-
mission is almost certain' to occur in everyone) ; the comparison of the patient's
pulse with one's own, or with that of a person of definitely equable temperament ;
the comparison of the pulse with that which should be present at a given season.

DETAILS

520. (1) Amount of Expansion. — The kind of -pulse in.
terms of the three dimensions : length, breadth and thickness.
There are nine variations in regard to one dimension alone, and
these are called " simple," and there are nine compound varieties.

§ 216. Broadbent remarks (" Pulse," 115 p. 7 footnote) that the^classificationof
pulses according to length, breadth and thickness is superfluous. " Deserting the
path of observation, Galen did not see that a cylindrical tube would expand equally
in all directions, and that there could not be any difference between its breadth and
depth. . . . The permutations and combinations of large, moderate and small pulses,
to the number of 27 varieties of pulse — an over-refinement on purely theoretical or
transcendental grounds, which led to extreme confusion."

290 THE CANON OF MEDICINE

§ 217. A careful consideration of the text of the Canon, in conjunction
with the Chinese writings, suggests that something more was in mind. One is
dealing with waves, not with cylindrical tubes merely. There is a subtle distinction
between breadth and thickness. Every tiny portion of an artery is fluctuating
continuously both in health and disease in virtue of its vasomotor endowment ;
and it is this that is sought. Here, as in so many matters in regard to the living
being, the simple mechanistic conception leads to error (and to scepticism about the
existence of unthought-of detail). It is possible in the physiological laboratory to
reduce the (experimental) animal into something very nearly a mechanism, or
actually into a mechanism, and in that way secure results which triumphantly
prove the contentions offered ; but the living human being with the full possession
of all his faculties constitutes a very different " proposition." Moreover, observa-
tions on the more subtle vibrations, as by biometric study, go to suggest that there
may be reason in the ideas in question (cf. Baraduc 110 ).

521 o The simple pulses are : the long, the short and the
mean ; the broad, the slender and the mean ; the deep, the
elevated and the mean.

The long pulse is one which is longer than normal. This
is the type appropriate to a person of equable temperament or
else approximating to this. The difference between the natural
and the equable has been already made plain. ^

The short pulse is contrary to the preceding.

The mean between these two extremes completes the first

group of three. The remaining six can be understood on the

same lines.

Short pulse : Impact sudden ; acme momentary ; subsidence of wave abrupt,
dicrotic wave present ; artery large ; tension low.

Long pulse : Impact deliberate ; acme persisting ; subsidence of wave gradual ;

artery contracted.

Normal pulse : impact sudden, acme moderately high ; subsidence of wave

gentle ; tension moderate.

522. As regards the compound pulses, some have received
distinctive names and some have not. A pulse which is increased
both in length and breadth as well as in depth is called " large."
When all these dimensions show diminution, it is a " small "
pulse. The moderate pulse is the mean between these two.

A small pulse may seem to be a large one in a wasted subject ; hence the pulse
may be palpable in arteries in which it is not usually felt. The aorta may be felt.
A pulse may seem small because carelessly felt in a person with a thick wrist.

A pulse which is increased both in breadth and depth is
called " thick " ; one which is diminished in these two dimen-
sions is called " slender." The medium pulse is the mean
between the two.

523 (2) Quality of impact. The varieties are three :
strong — this resists the finger during expansion ; weak' — the
opposite character ; and the intermediate.

Strong or violent pulse. — Impact strong ; acme high ; artery incompressible.
Occurs temporarily in emotional states, or after the bath. It is habitual in persons
of passionate nature (Aeg).

THE CANON OF MEDICINE 291

Weak or feeble pulse.— Impact faint ; acme low ; artery between beats is
compressible. J

524. (3) Duration of cycle. There are three variants :
rapid or short or swift — where the movement is completed in a
short space of time ; slow or sluggish or long — the contrary ;
and the intermediate, or moderately quick pulse.

525. (4) Consistence of artery. There are three variants:
soft or easily compressible ; hard, firm or incompressible ; and
one of moderate compressibility.

526. (5) Fullness or emptiness. The full (high) pulse seems
to be overfull of humour and gives the impression that it needs
liberating. The empty (low) pulse is contrary in character.
There is an intermediate' between the two.

Empty pulse: the artery feels as if it contained bubbles of air, so that the
Sflutf'T ° n an Smpty plaCe ( Ae S ineta )- (Chinese simile : "the hole in

527. (6) The feel of the pulse. Hot, cold or intermediate.

528. (7) Duration of pause. Hurried (" dense "), where
the period between the two successive beats is short ; sluggish
C' rare "), where the period is prolonged. And there is a mean.
This period of time is recognized from the contraction-period, but
if contraction cannot be perceived it is estimated from the
period between two expansions. In this case it is reckoned
from the times of the two extremes.

529. (8) Equality or inequality. This is reckoned according
as the successive pulses are similar or dissimilar, there being a
difference of size (large or small), strength (strong or weak),
swiftness_ (rapid or slow; prompter sluggish), hardness or soft-
ness, until it happens that the second expansion of the first pulse
is overtaken by the first of the next (due to excess of innate heat),
or is weaker than the next (excess of weakness).

If desired, one could expand this discourse and consider
the equality or inequality in regard to the three variants in the
other features of the pulse already named. But it is sufficient
to consider them only in regard to strength.

Regular (" equal ") pulse in the strict sense is one which
is regular m all these respects ; if it is regular only in one feature,
it is so specified. Thus we speak of a pulse as regular (" equal ")
in strength or regular in speed. In the same way a pulse is irregu-
lar either in all respects or only in one.

Equal pulse : this is always regular
OTlH ^ n , eC1Ual P ulse is n ° t altogether irregular. Supposing it to have no equality
and yet to preserve a certain period, such, e.g., as to extent of diastole if there are
two great and one small, then again two great and one small, and so on such a pudse

2 92 THE CANON OF MEDICINE

is unequal but regular. ■ If it not only had no equality, but also no order in its in-
equality, such a pulse would be not only unequal, but also irregular. — So, too, with
the other kinds. .

" Not only may an inequality in the time of motion take place in regard to one
pulsation in one part of an artery, but also in regard to the strength of the power ;
not so, however, in regard to the extent of dilation (for it is impossible that the same
pulse in the same place should be great and small at the same time), nor in regard
to the other kinds of pulses. But in different places different parts of an artery
may exhibit a double inequality in one pulsation. For the motion may continue
constant, and be swifter- at one finger, and slower at another ; or it may intermit,
and one finger may perceive it, and another not. And also, in regard to the extent
of the diastole, the same inequality becomes apparent in different places."

Irregular pulse. — Sometimes there is altogether an irregularity, observing no
periods whatever. Sometimes there is regularity as to periods, but, having no
continued order, they may in this respect be called irregular, but in so far as they
observe a certain period regularly, they are regular as to their periods. E.g., two
great, two small, three great, three small, and so on. (Aegineta, after Galen.)

530. (9) Orderliness or disorderliness. There are two forms :
the pulse may be irregularly orderly or irregularly disorderly.
The orderly pulse maintains orderly succession. This occurs
in one of two modes. The orderliness is absolute, where there
is every feature maintained ; or cyclical, where there are^two or
more irregularities which keep on repeating in cycles, as if there -
were two cycles simultaneously, or superposed, so. that the
original order reappears.

In this way it becomes evident that the tenth feature belongs
here, in a certain sense ; so that those who restrict the features
to nine instead of ten are justified.

531. For one must now see the musical character of the pulse.
For in the art of music sounds are juxtaposed in orderly relations
of loudness and softness which keep on repeating at regular
intervals ; rates of utterance vary — some sounds coming close
to one another, and others being further apart ; the attack
may be abrupt or gentle, sharp or dull. The notes may be
sounded clearly or be indefinite ; they may be strong or weak ;
the volume may be full or " thin." The rhythm of the sequence
of the sounds may be regular or irregular.

In feeling the pulse, all these features are also to be met with.
The intervals between the beats, or the successions, may be
harmonious or inharmonious. So, too, the irregularities may be
orderly or disorderly. It is orderly when there is a proper
relation of strength and weakness. It is disorderly if there is not.

All this belongs to the question of order and regularity. _

532, Galen indeed discussed the metre of the pulse, or its
rhythm along the lines of musical nomenclature. Thus we would
have double time, three-four time, common time, four-five time,
five-six time, and so on. For those who have a sensitive touch
and a keen sense of rhythm, with a training in the musical art,

THE CANON OF MEDICINE 293

such minutiae of observation could be correlated in the mind.
I am surprised to think how many of such relations could be
perceived by the sense of touchy and yet I am confident that it
can be done if one is habituated to the use of it, and can apportion
metre and beats of time. On the other hand, since these varia-
tions all belong to inequality and disorderliness it is not necessary
to define them particularly.

The analogy between pulse and musical time is found in the Chinese work
as well as in Avicenna. The fact that they compare certain beats with those pro-
duced on particular musical (stringed) instruments shows that they had something
in mind like that suggested above. The Kin pulse is so named after a musical
instrument of that name ; another pulse is compared with the vibration of the
thirteen stringed instrument named Tseng.

533. (10.) Metre. Even if the preceding details cannot be
perceived, at least the relation between period of expansion and
period of pause can be appreciated, as well as the relation be-
tween the total duration of beat and the total duration of pause.
Under this heading, then, we place : first total period of pulse :
next total period ; period of expansion : period of pause ;
period of expansion plus period of pause : period of contraction
plus period of pause ; period of expansion : period of contrac-
tion. A relation of period of expansion : period of contraction ;
or, period of first pause : period of second pause, is not important.

534. Metre (rhythm, " beat," accent) is good (eurhythm)
or bad (arhythm) according to the musical analogy. There are
three kinds of arhythm : (i) pararhythm, where the beat is altered
only slightly, and temporarily. Ex. : where the adult has a
metre which is only natural in youth ; where a child shows a
rhythm proper to an adult, (ii) Heterorhythm. This is a change
greater in degree. Ex. : where a youth has a metre proper to
an old man. (iii) Etrhythm. Here the change is to something
altogether different, as where the metre does not conform to
the human type at all. A great change of metre denotes great
change of bodily state.

§ 218 Relation between beats to musical time may be equally
exemplified from Arabic poetry, for the richness of the poetic metres
gives a simple and ample parallel. Cadences, pauses (corresponding
to intermissions of beat) of various lengths produced by the words
and phrases and intonations belonging to emotional expression
being natural sequences with evident relations to physiological
variations. A short passage of poetry may sometimes be sufficient
basis for a correct impression of the whole, but it is better to ,hear
the whole. So, in feeling the pulse, much may be learnt from
the observation of the beats for a minute or two, and yet it is better to
study a long series of beats in order to be sure there is no inter-

294 THE CANON OF MEDICINE

mission at all. This thought is applied in Chinese sphygmology . (See

§ 22 9)-

§ 219. Rhythmical successions of words — musical rhythm- —

• — effects on emotional state and on physiological processes.- — The
effect of words uttered in rhythm resembles that of musical suc-
cessions of sounds. The different forms of rhythm which are
adopted- in different kinds of poetry have each their own effect
on the emotional state, and tend to produce in the brain all the
concomitants of the emotional state which they themselves belong to.
Therefore the reciter is able to produce specific effects on the minds
of his hearers. For this reason, the idea of rhythm and cadence can
be pursued both in Arabian poetry and in Arabian music ; and it can be
pursued with respect to both aspects of aesthetics in any country or
language, though some languages are more potent in their influence,
according as they are intrinsically more, or less, musical.

We may note that as the rhythm, whether of words or musical
notes, evokes an influence on the pulse-rate in the course of their
effect' on the ear itself — both internal ear and the ear of the mind-
so the emotional effect will be produced even though the hearers are
not purposely or specially receptive. This emotional effect may be
inevitable, or it may be deliberate. To quote from numerous
passages in the " Nights,"—" touched with it a masterly touch, at
once exciting to sadness and changing sorrow to gladness . . .
went on to sing ... to many and various modes, till our senses
were bewitched, and the very room danced with excess of delight
and surprise " (163) ; " meseemed the doors and the walls and all
that was in the house answered and sang with him " (688) ; " played
a measure which made all hearts yearn " (37) (Burton, ii. 291 ;
iv. 322 ; i. 337).

When the effect is deliberately sought, it is stronger the more
thoroughly worked out the principle is — which explains why some
composers meet with more response than others, and why some
compositions are considered more perfect or attractive than others.
Yet a great composer may still be in ignorance of why that par-
ticular music should meet the need ; he may be guided by the
effect which the thought of the particular music has on his ■ own
organization ; or he may even work according to stereotyped lines
elaborated by theoretical developments and studies, without having
even " intuitive " feelings of his own. (Cf. Frederick Corder, 158 ,
p. 7). Music, the composer, the listener — all three show the same
possible aspects : the purely artistic, the emotional, the scientific or
intellectual ; and, more rarely, the inspirational and the celestial.
The number of listeners whom he will attract depends on the type
of music which the composer employs. In this way, for some
the pleasure is in the stirring-up of desire to accompany the music
with the bodily movements of various dances ; for others the pleasure
is through the feelings ; for others it is through the intellect (e.g.
the fugue) ; for others it is through some glimpse of the Abstract
Truth which such music renders possible, even though they under-
stand not what it is doing. But the last-named does not need

THE CANON OF MEDICINE 295

music in the ordinary, sense of the word (i.e., instrumental); it
is that of which it has been said : " The music of God is everywhere
for those whose hearts are open to -hear it."

We may also note that it is not only the pulse-rate and the
manner of the pulse beat which is influenced by the musical rhythm ;
the effect pervades the body*, because all the vibrations which belong
to the secretions and excretions, and to the nervous system throughout
are affected, and tend to harmonize, each in their own way — -the
successive waves becoming set so that all reach the same phase at
some same moment which recurs every so often. The movements
belonging, for instance, to the emergence of secretory granules from
a salivary or peptic cell, or an adrenal cell, alter in rhythm during
the time the" music lasts — and possibly for some time after. That
these movements are essential in the vital phenomena is easily
verified by studying such cells, e.g., in invertebrata, with the ultra-
microscope, or even by studying saliva itself.

§ 220. Additional remarks on Rhythm.

Let a and c represent the heart-sounds, and b, d the pauses. The ratio b jd is
remarkably constant, whatever the number of beats per minute. Exercise, excite-
ment, fever, etc., increase the rate, yet do not alter this ratio.

The normal rhythm is ab\c\d ; that is, " triple time."

Double-time is ab fed ; where the sound is " tick-tack," 5 is the same length
as d (for instance, owing to shortening of d). Such is what occurs in palpitation or
tachycardia.

If, however, b becomes long, it shows that the peripheral resistance is greater.
If a is stronger, b is longer. If the time is still triple, it necessarily implies that the
pulse-rate is slower. But if this rhythm now becomes double-time, it shows that the
resistance is too great for the heart, and that the heart is dilating or dilated. This
happens for instance in chronic renal disease, or acute renal dropsy associated
with myocardial change.

Four-time. — i. abjcjdjdj. The contraction is quick, the resistance is low.
This occurs in fever or in excitement. This rhythm tends to return to triple by
shortening of c to : abejdjdj. The pulse is short.

Such a pulse may follow on a double-time pulse ; for instance in chronic renal
disease. The prognosis is then grave.

A similar effect is produced if the cardiac contraction is not completed either
because the muscle is too weak or the resistance too high. To find such a pulse
forewarns the physician of cardiac asthenia forty-eight hours beforehand.

2. aajbjcjd. This is met with where the systemic and the pulmonary
pressure are not equal. The former may be too high from renal disease ; the latter
may be too high from pulmonary or bronchial disease. Where the heart is hyper-
trophied, such a rhythm denotes failing heart.

The second " a " is not usually loud, but it may be as loud as the first " a."
In such a case one could feel both ventricles beating separately over the apical
region, ab \c jc jd may appear simply by holding the breath. It may also appear in
mitral stenosis, in bronchitis with emphysema, in pericarditis, in pleural effusion
and in cases of cerebral tumour.

Five-time: a jb jc jc \d ; djbjcjcjd; ajbjc x jejd; or ajbjcjc^jd. These are
all variants of " bruit de galop." The problem to solve in each patient is : which
is the source of the second c ? Is it the pulmonary valve ? The causes are the same
as of the preceding. Pulsus bigeminus : db jc l d j jab jed j jab jc 1 d, etc., in the case of
the heart, but db jed jab jed j jab jed j etc., in the pulse at the same time. This type
is found in mitral stenosis under treatment. Another form : ab jed j jab jed j jab jed j j
etc., in the case of the heart and ab jed jd jd j jab jed jd jd j in the case of the pulse.
This type is found in more advanced cases, and in cases of epileptiform attacks.
It simulates alternate action by the two ventricles. Pulsus trigeminus ;
ab jed j job jee jd j jab jd jd j j

* Bearing on this is a recent paper by Swale Vincent and J. H. Thompson :
" the effects of music upon the human blood pressure." (Lancet, March 9, 1929, 534.)

296 THE CANON OF MEDICINE

Some heart-beats are too weak to reach the wrist ; or, in some cases too little
blood enters the heart. The pulse may therefore be irregular though the heart is
regular ; or the pulse may be moire irregular than the heart.

2. The Regular and the Irregular Pulse

535. Some say that irregularity (dissimilarity) of the pulse
applies- to a succession of beats or to any individual beat. But
when the irregularity is in the individual beat the various com-
ponents are diverse, — whether in the various places where one
applies one's fingers, or only at one particular point of appli-
cation.

536. When the irregularity is in regard to several pulsa-
tions there may be a regular succession of events. This begins
with one pulsation and there is a change to a greater or lesser,
following on regularly step by step until a maximum or minimum
is reached, after which there is a break, and the original cycle is
resumed. Or, the beats continue at the same level for a time,
and there is then an intermission and the original cycle is
resumed.

The whole cycle may show only one irregularity or it may
show two or more. In this case, it is as if there were two cycles,
distinct from one another, and yet keeping to one order, so that
the whole seems to be just one single cycle.

The irregularity may consist in the occurrence of a pause
when one expects a beat, or in the occurrence of a beat in the
middle of a pause.

537. When the irregularity refers to several components
of one single pulsation, this may be in regard to relative position
or to movement. And as there are six components there will be
corresponding irregularities : (a) expansion swift or sluggish ;
(b) premature or delayed expansion ; (c) strength or weakness ;
(d) largeness or smallness. All of this may be orderly and regular
or may vary by exaggeration or by deficiency — in two components
or in three or in four.

This may all be worked out for oneself.

538. Irregularity of the pulse in one section* is shown as
an intermitting or as a recurrent or as a continuous pulse.

The intermitting pulsef : one component is separated from
the next only by a short interval and a pause is interposed
in another, so that the two extremes of the pulsation vary in swift-
ness, sluggishness, and the like.

* Juz' : a section of the Quran. .

t Intermitting pulse : a smaller beat occurs after one or more great pulsations :
sometimes even the smaller beat is wanting. Intercurrent pulse: this is the

THE CANON OF MEDICINE 297

The recurrent pulsef : here a large pulse becomes small in
one component and then becomes slowly large again. In this
case there may be two kinds of pulse passing into one another,
so that, for instance, one pulse, by its irregularity, comes to appear
like two, or two pulses come to appear like one. Opinions
about this differ.

" When the radial artery is completely closed by one or more fingers till the
direct pulse is arrested, a feeble and retarded beat can be felt in the distal part of
the vessel. This is because the blood-pressure is low, and the arteries are relaxed,
and the force of the heart strong." 116 ((p. 52.)

The continuous pulse is one in which the expansion is con-
tinual and unbroken. There is a steady increase from slowness
to swiftness, and from swiftness to slowness ; from equality
to inequality ; from largeness to smaller, and so on. There is
no break in the change, for it is continuing the whole time.
Sometimes there is more irregularity in regard to some of the
components and sometimes there is less.

§ 221. Brief summary : —

Variations in rate of expansion : Sudden ; deliberate ; second expansion quick ; ■
or slow ; first sudden and then tardy, or' vice versa.

Rate of fall or contraction of the vessel : abrupt, or gradual and gentle.

Variations of degree of expansion : large, small, moderate ; forceful or feeble ;
alike in every beat or unlike.

Variations of duration of expansion : first short, then long, or vice versa ;
momentary ; persisting ; or mean.

Variations of duration of pause : first short, then long, or vice versa. Pause
'when there should be a beat ; beat when there should be a pause.

Variations of size of successive beats or between the beats : first diminished and
then increased ; first increased, then diminished. The size of the artery between
the beats informs of the constant pressure in the artery. To ascertain it, rolfthe artery
transversely between the beats ; it should not be palpable between the beats unless
the skin is soft and flexible and thin. Inability to feel the pulse between the beats
means low tension ; if easy to feel, the tension is high.

Variations in successive beats : the fourth beat may be irregular in one or other
respect, or the fifth or the sixth or the seventh. Every beat may be different
(irregular disorderliness).

3. The Varieties of Irregular Pulse which have received

Distinctive Names

539. Gazelle Pulse : [Syn. : goatleap pulse ; modern
"'jerking" ; "pulsus bisferiens "]. The expansion is inter-
rupted and occupies a longer time than usual and remains at a
•certain height and is succeeded by a swift increase to the full
height.

t> j

Just before the wave begins to subside a second heat is felt (Broadbent) — " a
•swifter spring than before" (Aegenita) — The two phases of the one beat are unequal.

opposite. When we are expecting an interval of rest, a supernumerary pulsation
•occurs. (Aeg.)

These two pulses denote impairment of the cardiac power, the degree being
greater in the intermittent than in the recurrent.

2 9 8 THE CANON OF MEDICINE

Cause : febrile heat. If the commencement of the diastole is feeble, and there
is increase in velocity towards the end and beginning of the systole, this shows that
putrefaction is prevailing, nature , hastening on the discharge of the fuliginous
superfluities But if, on the other hand, the commencement of the systole is feeble,
and the speed is towards the diastole, this means that heat is prevailing. _

In fever cases, such a pulse is accompanied by density, and sometimes by
largeness, if the artery is not too rigid. (Aeg.)

(This pulse is characteristic of pericarditis.)

540. Undulatory [" bounding " (modern) ; " like rolling
waves "]. The irregularity is in respect of largeness and small-
ness of artery, of degree of rise, and of breadth, and in the position
of the beginning of the beat (whether too soon or too late), and
also in softness. It is not very small ; it has a certain breadth,
recalling the movement of waves, which follow upon one another
in orderly fashion and yet vary in the extent of upward rise and
downward fall, and in swiftness and slowness.

Aegineta says : " The whole artery is not expanded at once, but first under the
first finger then under the second and so on ; like a series of waves. The wave may
be carried on straight or obliquely ; it may be high but short, low but long, broad or
narrow, unequal in speed and force." _

Rhazes says : " It is one which in breadth takes up much space of the finger ,
with this it is soft and full, but there is not much rise or fall ^one rise seems to join
to another until it resembles waves, one following the other.

541. Vermicular [modern " creeping "]. This resembles
the preceding, but is small, soft, feeble, and very hurried.
The closeness of the beats causes it to be mistaken for a swift
or rapid pulse.

The feel is that of a worm wriggling. It is a weak form of the undulatory
nulse The size of the artery is not of the same inequality at all times. I here
are waves of pulsation, the whole artery not being distended at the same time
(Broadbent). See 572.

542. Formicant Pulse. This is the smallest, most feeble
and hurried of all the pulses. [It is not a quick pulse,
though apparently swift. (Aeg.)] It differs from the vermicular
pulse in the great ease with which upward rise, anteposition of
beat or postposition is perceived. Irregularity of breadth is not
discernible. [It is a weak form of vermicular pulse ; and allied
in character to the " hectic " pulse.]

543. Serrate Pulse. This [modern " harsh "] pulse resem-
bles the undulatory in the inequality of the various components
of the beat — upward rise, breadth, anteposition and postposition.
It differs, however, in appearing harder, and in its components
being of unequal hardness. This pulse is quick, hurried, hard.
The irregularity is in respect of size of expansion, of hardness
and of softness (see 565).

544. Mousetail. There is progressive inequality of the
components — from decrease to increase, from increase to de-

THE CANON OF MEDICINE 299

crease. This may apply to several beats or only to one beat or
only to a part of a beat. The inequality is in respect of volume,
or of slowness (changing to swiftness), or of weakness (changing
to strength).

The artery, says Aegineta, feels swollen to the index finger, and very slender to
the last finger. _ He speaks of a •" failing or swooning myurus, where the smallness
ol the last beat is maintained ; and of a recurrent myurus, where the pulse resumes
its original amplitude."

545, Recurrent [modern " flickering " pulse]. This passes
from minuteness to a certain volume, and then fails progressively
until it reaches its former minuteness. It is like two myuri
placed together end to end.

" Your first finger feels it small, your middle finger feels it large and swelled
and your little finger feels it small ; the expansion is only slight."— (Aegineta ) '

Cause : weakness of arterial wall, and wasting of the tissues round the artery
bigmficance : extreme debility ; wasting from unresolved inflammation or any other

cause.

546. Dicrotic. Doctors are divided in opinion about this
pulse. Some regard it as a single beat in which antecession and
post-position are unequal ; others regard it as a double pulse,
one beat following the next too quickly to give time for the second
to produce full expansion. However, the presence of two beats
does not make two distinct pulses. A pulse which makes a partial
expansion and then resumes it, would not be dual. It would
only be dual if the artery were to fill first, and then pause and then
contract and again refill ; but otherwise it would virtually be a
jerking pulse.

§ 222. _ As regards the dicrotic pulse, some have regarded it as a wave reflected
from the periphery, but it is really the elastic recoil of the aorta that accounts for it
It is most distinct if the peripheral resistance is low. The semilunar valves form the
fulcrum of the rebound (Broadbent, p. 26).

^ • P? firSt ^ Sat of the P ulse is lar S e < the arter y rism g strongly to the finger •
then it stops and recedes ; the second beat is small. The artery is as if repelled at
the first beat and then trembles a little, and then quickly resumes its beat but less
strongly, and at too short an interval.

547. Fading or falling pulse. Here there is a pause in the
middle of the pulsation, as there is in the gazelle pulse. But in
the gazelle pulse the second beat begins before the first is finished;
in the falling pulse the first beat is completed before the second
begins.

548. The spasmodic, thrilling and twisted pulse. The latter
is compared with a twisted thread ; there is here an irregularity
between the precession and the later parts of the pulsation, both
in position and in breadth.

The spasmodic (or "tense ") pulse suggests that the artery is being stretched
and dragged and pulled by its extremities like a cord (Aeg).

t* Th t "l t 1 hrillin g ".(modern term), or tremulous pulse is hard, quick and frequent.
It suggests the quivering of arrows thrown with great force (Aeg.).

3 oo THE CANON OF MEDICINE

549 The chord-like pulse feels like a twisted cord (or sinew),
and is similar to the thrilling pulse. But in the chord-like pulse
the expansion is less conspicuous ; the departure from regularity
of position of rise is less evident ; but tension is evident ; the
twisting is sometimes only in regard to one portion of the pulsa-
tion. The two kinds of pulse are really equally common, and
equally liable to occur in " dry " diseases.

All the above are simple pulses.

550 The varieties of compound pulse (that is, where there
is more than one form of inequality or irregularity at once) are
almost innumerable. In any case they have received no special
names.

Additional Notes

s ,,, t The pulse is visible under the following circumstances : when
the radial artery follows an abnormal course, immediately under the skin ; when
the Sat ent is spare and the skin is thin ; when the tension is very high, and the
SoodSessels ar P e enlarged and tortuous; and (entirely pathologically) m aortic
Sgu«rtation^here the artery is empty and collapsed between the beats and the
Wood rushes in with extreme suddenness and violence, especially if the hand is
Sed Such Tpulse may be audible as well, and at the same time there is conspicu-
ous throbbing of P the carotids and temples and facial artery. The tension is here very
low indeed. ,, -,

Visibility is not mentioned in the Qanun ; and whether the empty pulse
vw= o+ cii with the " Corriean" or not, is not clear. It seems hardly
l^ffi» ^ **£ should^ot have been observed, even though they
could not know its explanation.

S-724 2 Hectic pulse. This occurs in marasmus and phthisis, I tie
components do no? vary greatly. The pulse suggests " being entangled and never
geS free » becaule thestateof disease is actually diffused throughout the body.
fh£ pulse therefore agrees with the Chinese type named like a toad embarrassed
by weeds." This may be simply a form of the thrilling" pulse.

S225 3 Pulse-rate. (Broadbent, " s , etc.)

Increased pulse-rate. -^Lowexed resistance quickens the pulse rate. Diurnal
variatiZ T the Cse-rate is greater in the evening, and slower m the early morning.
The fact of theater explains the following: morning headache; tendency to
depression of "spirits ; to awake tired; the tendency to asthmatic attacks and
epfleptic fits (tte blood-pressure is now minimal). Posture : the erect posture adds
e?At beats to the minute. Emotions : the rate is increased by fear (the force is
fSe) and anger (force violent) ; the explanation is that the tension is increased
bv the emotion! Exercise : at first the rate is increased as well as the force and
The pulse becomef" vehement." The explanation is threefold-(«) nervous
factors (6) musclar action drives more blood to the heart and fills up the right side ;
the hearths to beat quickly and strongly to get it through ^the dung, ^ accumula-
tion of blood in the lungs produces breathlessness and panting, hood . tne rate
S^ncreased after food and the vessels are relaxed. Drugs, etc.: stimulants
nrrease the rate and cause greater relaxation of the vessels ; alcohol and ether
belonfto this fate^ry Thef lower the peripheral resistance by acting on the cen-
^iwuslS^d also stimulate the heart directly; nitrites increase pulse-
rate and at the same time cause great relaxation of the artery. Pungent essential
oils and ammonia increase the rate and through the peripheral nerves relax the
Vessels Belladonna and atropin also increase the rate. External warmth : slight
increie of rate and slight relaxation of the vessels. Respiratory movements-czuse
irregularities.

' s z ,6 Increased pulse-rate in relation to morbid states : —

These diseases in which the rate is increased, show the same rate, even m
repose but exertion makes the rate increase inordinately, out of all proportion.
Emotional disturbance has the same effect.

THE CANON OF MEDICINE 301

In pyrexia : the rate rises according to the degree of fever, but chiefly according
to the effects on the system and according to the patient's reaction to the disease
The peripheral resistance falls. The force may be increased (sthenic fever : pulse
frequent, sudden, vehement, large, short, dicrotous) or diminished (pulse weaker
less sudden, less large, dicrotous). Towards the end of the illness, the weaker the
patient, the greater the rate ; even a few beats more per minute are serious In
septic fevers (septicaemia : modern term) a quick rate forewarns of shock, and a
fatal issue (in puerperal cases). A " racing " pulse is a danger sign.

Among special fevers : scarlet fever is characterized by a very quick pulse-
rate (120-200). - ■/ •> u .r

§ 227. Specially quick pulse-rates. — In young people : overstrain from
athletics; the "irritable heart" (the blood-pressure is high). In older people-
sudden single acts of excessive exertion (sudden dilatation of the heart). Special
cases : paroxysmal tachycardia : due to flatulence, emotions, gout ; gastric trouble
The pulse is frequent, short, variable in fulness and strength, not vehement, occasion-
ally irregular. The heart-sounds are confused and short, . and cannot be analysed.
May arise suddenly from a fright or sudden noise, or violent emotion.

(In this condition the motion of the blood is not accelerated. It is a vibratory
alternation of pressure with little onward movement. The left ventricle is not
dilated._ It may be that the ventricle is not expanding properly. Cf. auricular
fibrillation ; auricular flutter. This form of pulse must be among those described
by the Chinese, but certain identity has not been reached).

The quick pulse of " Graves' disease" might be included here.
Middle-aged and elderly women : here the occurrence of throbbing aorta may
be referred to, though it is not a true " quick pulse " ; it arises from lack of tone in
the aortic wall.

§ 228. Decreased pulse-rate. Increased resistance slows down the pulse
Habitually low pulse-rate (bradycardia) forewarns of the risk of cramp when
swimming. In this category belong— the slower rate of jaundice ; of fatty degener-
ation of the heart (not often met with here) ; the special pulses : pulsus bigeminus
and pulsus trigeminus : heart-block.

§ 229. 4. Intermissions. Irregularity.

On the one hand there is a variation of force between successive beats ; on
the other hand there is a drop of a beat, or an interposition of a beat.

Intermissions may be habitual or constant, the person being unconscious of
it except during exercise or excitement. It is accentuated when the body is fatigued
or the disposition is nervous. The patient is conscious of it during pyrexia.

Occasional intermissions are produced in shock ; in hypochondriasis after the
use of tobacco ; in fatty degeneration of the heart. In these cases the heart itself
is beating, though hurriedly and imperfectly.

Irregularity is habitual in mitral regurgitation, where it is produced by the
variations of pressure dependent on breathing. Inspiration forces blood into the
left ventricle, expiration sucks it out of the left auricle. A similar occurrence
is found when _ the heart is dilated, and under nervous conditions.

Irregularity is occasional as a result of flatulence of the colon, or stomach
which disturbs the action of the diaphragm ; as a result of tobacco.
Irregularity is usually more serious than intermission.

Rules in regard to intermission found in Chinese textbooks : — Omission of
one beat after forty shows a lack in one of the five " noble " organs : " death will
follow m four years, in spring." If there are no intermissions within fifty beats, the
health is perfect. But if there is an intermission then, it has a similar significance
to the preceding and shows " death will follow five years later." (See § 218.)

Other rules cannot be presented without also discussing the theory of the
relation between pulse-type and physiological value of the several organs Thus
an intermission of one in 12, or 19, or 26 (and so on), beats differs in significance
according as the pulse-type is' " heart," " lung," " liver," " kidney," and so on.—
After all, such a classification is justified, and it should be easily understood that
intermissions under such circumstances might have distinct significances.

§ 2 3°- 5- Relation of pulse-rate to respiration-rate. In the Chinese works
this form of observation replaces our own habit of estimating the number of beats
per minute, and also the number of respirations per minute. In health there should
be four beats to one respiration ; five beats in the same period is allowable as consis-
tent with health. But over five is pathological, and eight beats is a bad prognostic
™f?' reductl0n to three or two is pathological and a reduction to two is a bad sign
When death is imminent there may be only one beat to two respirations. Full
details are stated to be given in " the book of eighty-one difficulties "

3 o2 THE CANON OF MEDICINE

4. The Pulse designated as " Natural."

551. Each of the above-named varieties (of pulse) neces-
sitates a distinction into " increased " and " diminished." And
that which is " natural " among them is the " equable " pulse,
except in the case of the strong sort. For (here) the " natural "
pulse is excessive as" to strength. But in other cases, the increase
is in natural proportion to the increase in force, so that, for ex-
ample, as it becomes greater, it is " natural " for it also to be
forcible.

As for the sorts (of pulse) in which there is no possibility
of increase and diminution, in such cases the " natural " pulse
is the one which is even (equable), regular (orderly), and of good

rhythm (weight).*

Paraphrase.

Amongst all the varieties of pulse which have now been des-
cribed, there are two classes, (i) Those which show degrees of
qualities : namely, increase above, and diminution below, a " mean."
(See 521-528). (ii) Those which do not. Thus, a dicrotic
pulse cannot be more, or less, or intermediately dicrotic ; an ir-
regular, pulse cannot show a " mean " irregularity.

The " natural " pulse in the first group is one which shows a
mean quality in respect of every feature except that of strength (523)
for the natural pulse is strong (forcible).

The " natural " pulse in the second group is one which is
uniform, regular (orderly), and eurhythmic.

This rendering brings out the real meaning of the word " natural " — tabi'yya.
It is not synonymous with " normal," but refers strictly to " the nature "-—i.e.,
the state of the vegetative soul, when in health. (< ;j

In short, a pulse which is " mu'tadil " is not therefore necessarily " normal ;
still less is it necessarily " natural."

A pulse may be (a) natural and normal, (6) not natural, yet not abnormal,
(c) not natural, and also abnormal.

5. The Factors concerned in the Production of the

Pulse
552. The factors concerned in the production of the pulse
are (i) essential and integral in the constitution of the pulse.
These are called " contentive " factors ; (ii)_ non-essential :
comprising two groups, (a) inseparable — that is, if they were
altered, the type of the pulse would be altered ; {b) separable ;

* It may be noted that the close resemblance between the Latin version and the
corresponding passage in Galen makes it seem as if Avicenna had simply introduced
a translation into Arabic from Galen. But in the Greek the natural pulse is simply
a mean between extremes, and is so called presumably because usual m health;
whereas with Avicenna this is not so ; he speaks of a distinct kind of pulse, and is
truly consistent to his usage of the term " nature "—the outcome of the great
thesis "the body is a unity "—throughout his physiology, pathology, and
sphygmology.

THE CANON OF MEDICINE 303

that is, a change may be produced in them without- affecting
the type of the pulse.

There are three contentive factors :

1. The (vital) power of the heart, producing the

expansion.

2. The elasticity of the artery.

3. The resistance, or urge.

The last-named is, in Avicenna, taken to be a question of the degree of innate
heat, and its relation to heat-loss ; not a question of peripheral resistance as a factor
m producing blood-pressure.

The influence of the three factors varies with the non-
essential factors which may be associated with them at the given
time.

553. List of non-essential factors :

1. Natural (i.e. pertaining to the nature) — Age (manhood,
youth) ; temperature of air (hot seasons ; hot localities) ; tem-
perament (hot temperament).

2. Non-natural : exposure to very hot atmosphere ; use
of hot baths ; vigorous exercise or gymnastics ; influence of
food and wine ; influence of calefacient medicines.

3. Preternatural : emotional states ; secretiveness (hiding
anger, concealing the fact of having taken a heating medicine
in spite of the physician's enquiry) ; cunning persons who easily
conceal matters relative ; habits of the patient ; " hot " in tem-
peraments ; decompositions occurring in the fluids (in the
stomach or tissues).

6. The Effect of the Contentive Factors upon the

Pulse

554. Large Pulse. If the arterial wall is at the same time
yielding, and the vital power is strong, and the resistance
excessive, the pulse will be large. The resistance is the chief
factor in the production of a large pulse, for should the power
fail, the pulse will naturally weaken ; and if the arterial wall
were also hard, and the resistance lowered, the pulse would be
even smaller.

An unyielding artery will also make the pulse small. But
the difference between a small pulse due to inelastic artery and
one due to weakness is that in the former the pulse is hard and
not weak or short or low as in the latter.

Low resistance also makes a small pulse, but it is not weak.
Weakness is the chief cause of all three forms of small pulse.
Granted the power is constant, lack of hardness of the artery

3 o 4 THE CANON OF MEDICINE

has more effect than lack of resistance, for there is nothing to
prevent the artery from expanding.

The temperament has not much influence unless the resist-
ance be lowered.

If the resistance be great and the power strong, and the
artery inelastic, the pulse becomes swift. The swiftness makes
up for lack of size of pulse. But if the power be not adequate,
and the pulse is therefore unable to become large, and therefore
not swift, it necessarily becomes brisk, and this briskness makes
up for the lack of volume and swiftness. Several beats of this
kind would become equivalent to the effect of one adequately
large beat, or of two swift beats.

555. It is like a man wishing to carry a very heavy weight ;
if he is able to do so, he will carry it in one journey, though with
difficulty ; or he may divide it into two, thus making each
journey more easily ; or, if he cannot manage even that, he will
divide the load into many portions, and carry each one as leisurely
or as quickly as he wishes. He need not rest himself between
the journeys, though he may choose to linger. But if he were
very weak, he would stop and rest awhile between the loads,
and as he becomes tired with the journeys would perform them
more slowly.

556. If the vital power be strong, and the artery responsive,
and the resistance moderate, the effect of the power would be
to make the pulse more swift and of greater volume. But if the
resistance were greater, there would be briskness as well as large
volume and swiftness.

557. The factors which go to make a large pulse also go
to make a long pulse, if rise and fall are hindered in any way.
For instance, a hard artery cannot widen, and tough flesh and
skin, especially if the tissues be wasted, prevents the artery from
rising to the finger.

Variants of Large Pulse, and their causes (Aeg.) :—

Large and also soft : hot baths.

Large and also hard : hot intemperament, especially if there is dryness of the

system.
Large and mean between hard and soft : massage ; exercise.
Large and vehement : wine ; anger.
Large and unequal: concealing anger; deceiving the doctor m regard to

definite questions, as to possibility of heating factors.
Large and also a hasty contraction : putrefactive changes in humours. _
Large and also quick and dense : increase of heat in the heart from various

causes. . , . . ,

Large only in appearance : emaciated state of the tissues at the wrist.

558o The Causes of Pulses bearing Distinctive Names
Broad Pulse. Emaciation may make a pulse appear broad.

THE CANON OF MEDICINE 305

Emptiness of vessel also makes a pulse appear broad,
because the two walls come into apposition. A very soft artery
gives the same effect.

Causes of broad pulse : redundance of humidity from natural causes or from
external causes, such as a soft artery (Aeg.).

559. Hurried pulse. The causes of a hurried pulse are :
weakness ; great resistance ; heat.

560. Sluggish -pulse. The causes of a sluggish pulse are :
power relatively greater than resistance ; great coldness due to
resistance ; great loss of vital power ; approach of death.-

561. Feeble pulse. The causes of feeble pulse are : loss of
natural power by lack of food ; emaciation ; excessive discharges;
insomnia ; too much exercise ; solicitude ; morbid change in
the humours ; movement of the humours, especially into a very
sensitive member, or into a member which is in relation with the
heart; any source of intemperament ; pain (producing syncope) ;
sadness, grief and other mental states or cares ; any factor
whereby the vitality is markedly depressed. (Note also : age,
season, locality ; temperament.)

Cause of change from feeble pulse to strong pulse : la) when the vitality
becomes strong again, after being enfeebled from lack of food, wakefulness im-
m ? ^ ® vacuatl0ns « g rief > cares, syncope, or any cause of intemperament.
(d) When humours are matured ; when noxious substances are excreted when there
is passion, when an intemperament is rectified ; also after use of certain foods
of wines ; after exercise. (Aeg.) '

562. Hard pulse. The causes of hard (" tense ") pulse
are : dryness of the arteries and great stretching of the arteries ;
intense cold.^ The pulse may become very hard at the crisis of
an illness owing to the intensity of the conflict between the person
and his disease, for all the members are implicated. (This pulse
is usually also small, quick, and sometimes frequent.)

Hard pulse must be distinguished from a strong pulse. The latter is usually
also large, swells up and strikes the finger forcibly. A hard pulse cannot be large
for the artery is unyielding ; a hard pulse is also small, quick, and sometimes dense'
(Aeg.)

Causes of hard pulse : hardness of artery; this is due to immoderate cold
dryness, or tension of inflammation, or spasm. (Aeg.)

Cause of strong pulse : the force of natural vitality, associated with hardness
of the artery (Aeg.).

563. Soft pulse. The causes of soft pulse are : "natural"
agents with an emollient action, such as aliments (more abundant
diet ; liquid food). Morbid states which tend to emollient
effect : e.g. dropsy, sleepy-sickness, coma, disorders arising from
or m a serous humour. Mental states, such as hilarity. Agents
which are neither " natural " nor morbid : e.g. bathing (to-
excess).

3 o6 THE CANON OF MEDICINE

Other causes (Aeg.). : humid state of artery due to (a) preternatural causes :
coma, lethargy, dropsy, affections related to the serous humour. (6) Non-preter-
natural causes : more liquid food, much sleep, a more abundant diet, immoderate
baths ; hilarity.

564. Irregular pulse. If the vital power be maintained, the
cause will be heaviness [in substance] of the food, or of some
humour.- If the vital power be weak, it shows a contest between
causative agent [of "the illness] and the tissues. Other causes :
(a) overfullness of the vessels. This would be remedied by
venesection. ( b) Viscidity of the blood. In this case the breath
becomes choked in the vessels. This form of pulse is especially
liable to occur when the breath is also imprisoned in the cardiac
region — e t g, by an over-full stomach, which produces this effect
very rapidly ; or by anxiety ; or by pain.

If the stomach contain depraved humour, the irregularity
increases until cardiac tremor comes on, and a thrilling pulse
(tachycardia !) results.

If the irregularity is orderly, it betokens lesser constitu-
tional injuries ; if disorderly, it shows that there are more
serious constitutional defects to deal with.

565. Harsh -pulse. This pulse shows a varying consistence
of the artery which is produced by changes in the composition
of the (circulating) humours, whereby decomposition products,
" crudities," or products of maturation diffuse through the vessel
wall and affect its mode of expansion. Inflammatory deposits in
fibro-muscular organs (e.g. diaphragm, pleura : "Rhazes) also
render the pulse harsh.

If the harshness be slight, it shows that the inflammation is mild ; if more
marked, it means that the case is severe and dangerous, with a danger of empyema
or tuberculous change (Aeg.). See 543.

566. Dicrotic pulse. Vital power is strong ; the artery is
hard ; the resistance is considerable. The artery does not at
once yield to the force. It suggests a person wishing to sever
something at one blow, but failing to do so until helped out, for
instance by a sudden dire need to achieve it. (Significance :
approaching crisis).

567. Mousetail. Such a pulse is produced when the^ vital
power is weak, as a person who ceases manual labour, or is re-
suming it after a rest. If it is constant, it shows that the loss of
power is greater. However, as long as the pulsation is mousetail
in type (and the similar forms) it shows that there is some vitality
left. But it is apt to pass on to the terminal mousetail, then to
continuous mousetail, and finally end in the grave " recurrent
mousetail " (" swooning " pulse).

THE CANON OF MEDICINE .307

Recurrent mousetail means : (a) failing vital powers, with a greater or less
■degree of prostration ; (6) weak power, which is still struggling on in face of the
•odds (Aeg.).

568. Fading or falling pulse. The vital power is enfeebled
or waning, and inadequate. It is also produced by a sudden
change in the " nature " and in the mind.

569. ■ • The spasmodic or tense pulse. This is produced when
there are non-natural movements in the vital power or when the
artery is itself unhealthy.

Significance : inflammatory changes at the nerve-origins (meningitis, acute
epilepsy). It can be felt after death has taken place, while the body is still warm
{Aeg.).

570. Thrilling pulse. Here the vital power is strong ; the
artery is hard ; the resistance is great. Without these conditions
it cannot arise.

It denotes inflammation in fibro-muscular tissues which are well supplied
with nerves. A strong expansion is required, with adequate vital power. The
hardness of the artery prevents adequate expansion.

^571, Undulatory pulse. This usually means chiefly a lack
of vital power, expansion being hardly achieved, if at all, and
then only little by little. If the artery is soft, this would itself
suffice to produce the effect of waves, even though the power
were not much reduced. A soft and moist artery does not respond
to an impact, and does not allow every part to be expanded ;
whereas a dry and hard artery does — dryness being responsive
to impact and tremor. An artery which is both hard and dry
will transmit expansion at once ; the soft and moist artery will
only do so at the beginning of the pulsation, expansion and alter-
ation of form of the vessel subsiding suddenly so that the other
fingers do not perceive any movement.

The beats are indistinct ; the dicrotic waves blend. At the same time the first
cardiac sound disappears.

Significance : crisis approaching by sweat (Rhazes, Halv Abbas), or by
bowels ; humid affections like sudden dropsy, lethargy, peripneumonia' (Aeg ) •
typhoid fever ; and malaria ; extreme cardiac asthenia (Broadbent).

572. Vermicular and formicant pulse are produced by great
weakness, and so the pulse is sluggish, the intervals between
the beats are short, and the components are unequal. This is
because the artery is unable to expand at once, but onlv little
by little. (See 541.)

Significance : sudden loss of vital power due to excessive haemorrhage diar-
rhoea, cholera, etc. Failing life (Galen).

In the formicant pulse the powers of life are at a still lower ebb than in the case
of the vermicular pulse (Aeg.).

Chinese simile: to a silk thread (§214).

3 o8 THE CANON OF MEDICINE

573. Pulse of faulty rhythm. If this occurs during a time of
repose, it is due to an increased resistance. If it occurs during
exercise, there is an increased -weakness (of vital power) or de-
ficient degree of resistance. The pulse of exercise produced by
swiftness of expansion is something different to this.

The' duration of the pause is lessened in old age. Equality between expansion
and pause denotes a normal temperament of the body. It occurs m early life
If the pause is greater in duration than the expansion, the temperament is hot
(e.g., adult) . If the pause is less than the expansion, it shows that the temperament

iS COl Change t of rhythm changes the rate and frequency of the pulse. (Aegineta.)

The causes of full, empty, hot and cold, deep (high) and
low pulses are evident.

Full Pulse is produced by plethora from food or wine ; or any mere abundance
of fluid-intake ; empty pulse is produced by lack of nourishment, or undue dis-
charges The pulse Jells warm (af if there is great heat in the heart-the rest of the
bodv being cold ; (b) if the artery is in a sort of spasmodic state ; (c) m catalepsy,
and in persons who are becoming comatose. (Aegineta, quoting Archigenes.)

§ 2 ,j The influence of low resistance upon the pulse. Ihere is a sudden
impact ; the acme is brief ; the subsidence rapid and the dicrotic wave « present
As it subsides quickly under the fingers it is called hurried If at the same time the
heart beat is forcible, the pulse is '< full and bounding '-large sudden impact
vehement ; artery easily flattened. If the heart is beating feebly, the artery is
narrow ; the pulse is small, easily compressed ; the impact is not sharp and there-
• fore the fingers must be applied very lightly in order to be able to feel the pulse.
An extreme degree of this kind of pulse constitutes the running pulse, bphyg-
mographic variants are : hyperdicrotic, and " anacrotic (which is a form ol

Clinical causes of low resistance : (a) congenital, (b) transient : after a hot
bath in fatigue, in exhaustion ; after a meal, especially a hot meal ; lack of nitro-
genous aliments ; alcohol, (c) Emotional : anxiety, depression (d) Morbid states :
obesity fever; flatulence; constipation; sleeplessness; headache; nervous,
conditions ; chlorosis ; fatty degeneration of heart. .

Other facts— A low resistance occurring in a person with a high tension is-
a bad sign ; a person suffering from habitual constipation, and having a low blood-
pressure? should not be given purgation, much less mercurial purgation.

8 2^2 The influence of high resistance (high tension) on the pulse. This
depends on the force of the heart. The pulse is full between the beats ; the artery
feels like a tendon or the vas deferens ; or is even visible under the skin lhe
arterv is large or small. It may be thrown into a curve ; there may be nodosities-
along the artery. The wave is gradual ; lasts too long ; subsides too slowly ; seems-
weak but is more plain when one presses harder. There is no dicrotism.

A variant called " virtual tension," is where the artery is large and full be-
tween the beats ; moderate pressure does not make the pulse seem stronger ; it is.
compressible • the impact is sudden, the acme is short, and the subsidence is sudden.
Such a pulse shows that the heart is unable to cope with the resistance.

Clinical causes : excitement ; exertion ; external cold (which drives the blood
from the surface) ; migraine; early meningitis ; early acute nephritis (the water
cannot get out through the kidney) ; plethora ; presence of certain waste products,
in the blood which cause the small vessels to contract.

§233. Types of pulse and various conditions (modern).
Sleeplessness.— Two types of pulse, (a) Impact gradual ; acme long ; may sub-
side suddenly ; artery large or small ; full between beats, and usually not easily
compressible. It may be weak and yielding. The condition m this respect depends.
on the state of the heart. (6) Impact sudden ; acme short ; artery full between
the beats • low tension. A sleepless person with such a pulse will be able to sleep
readily in the daytime ; he may be able to sleep sitting up though unable to do so.
lying down. The pulse is unstable.

THE CANON OF MEDICINE 309

Emotional excitement.— -Impact strong ; rate increased.
Fevers : —

Catarrhal. The pulse varies according to the degree of obstruction to the
pulmonary circulation (bronchitis, e.g.).

Pneumonia. Pulse frequent, large, vehement, dicrotic, not short, not com-
pressible. The pulse can be felt with the third finger after pressing hard with the
index finger, because the pulsation goes round the radial arch. When the lungs
become engorged more and more, the artery is small, the beat is weak, but the heart
itself is very, forcible, working hard to get the blood round the lungs Violent
heart action and weak pulse 4 (Venesection indicated !)

Diphtheria. At first the pulse is weak and small especially if the heart is
affected. The heart rhythm is abjcjdjd or ab jc jd jd jd Id.

Erysipelas. Large, soft, very dicrotic ; tends to become undulating.

Septicaemia. Artery small ; pulse rate 140-200 ; beat sharp ; compressible ■
tick-tack "heart. The pulse varies much in different cases.

Pyaemia. Pulse frequent, and sharp, apart from the degree of pyrexia The
pulse is that of shock.

Acute rheumatism. The character of the pulse varies with the degree of in-
flammation in the joints, etc.

Inflammation of serous membranes. First, small, long, frequent, hard, full
between beats ; not easily compressible. Later — shock : very small, weak 'com-
pressible ; " wiry " or *' thready " pulse due to the filling up of the abdominal vessels.
These characters are more noticeable with peritonitis than -with pleurisy.

Cerebral conditions : —

Tumour. Rate slow ; artery full between beats. Later on the impact is
very weak, and the acme short ; the artery small ; the artery empty between beats
{denoting feeble heart and relaxed arteries).

Coma. The pulse varies with the state of the heart.

Convulsions. Impact strong ; rate increased ; tension lowered ; the blood-
pressure is sometimes increased, sometimes low.

Epilepsy. Low tension is a bad sign ; if a high pressure is present and con-
tinues, the case is tractable. The tension is always high in senile cases.

Meningitis. Early cases show the " hesitating " pulse ; the force is not
■quite constant ; the time is not quite regular. The impact is deliberate, the acme
long ; the artery is contracted. The rate is slow. Later on, the rate becomes
■quick; there is no tension (owing to compression of the brain).

7. The Effect of Age and Sex on the Pulse

574. Male Sex. The pulse is larger and much stronger,
because the vital power and the resistance are both marked. The
pulse is slower and more sluggish than in women because the
degree of resistance is so great.

If the vital power is maintained, and the pulse is brisk, it
must needs be swift. Swiftness comes before briskness. Hence
the pulse of males is slow, and is necessarily also sluggish.

575. Late childhood (7-14). The pulse is softer because the
temperament is moist at this period. It is weaker and more brisk
because the innate heat is abundant. The vital power is not great,
for growth has not yet become complete. Considering the small
size of the body at this age, the pulse is large. This is because
the artery is very soft and the resistance strong, and the vital
power is not small — considering the small bulk of the body (at
this age). Compared with the pulse of adult life the pulse at
this age is not large but quick and more brisk (due to the resist-
ance). This is because at this period of life there is a greater

3 io THE CANON OF MEDICINE

aggregation of •" fumosities,"* consequent on eating so
often and so liberally — -wherefore more frequent evacuation
becomes called for and " ventilation " of the innate heat is
desirable.

576. Early adult life (2 1-35). The pulse is large, not very
swift—indeed inclined to be slower and less brisk ; the
tendency is to become sluggish. At the beginning of this
period of life the volume of the pulse is greater ; and at the
middle of the period it is stronger. The innate heat, as we have
stated, is about the same in adolescents and in young adults ;.
there is therefore about the same resistance in each. The vital
power is greater at this period, and the greater volume of pulse
therefore "compensates for the lack of swiftness^ and frequency.
Vital power is the main reason for the pulse being large at this
time of life. The resistance is next in importance, and the state
of the arterial wall is the contributory factor.

577. Elderly persons. The pulse is here smaller because
of the weakness of the vital power ; the swiftness is lessened
both because of this and because of the lessened resistance. Such
a pulse is therefore more sluggish.

578. Old age. In advanced years of life, the pulse becomes
small, sluggish, slow. If it be also soft this is because of extra-
neous, and not natural, humours.

§ 234. From the Chinese. — In the male sex, the pulse at W should be more
brisk than at C ; in the female sex it should be more brisk at C than at W. From
deviations of normal character of the pulse in women one may become aware of
menstrual errors ; of the presence or not of pregnancy, and the size of the pregnancy.
The C pulse is noted for these purposes, and the right arm is used. — The exact
details required for diagnosis require the application of the special nomenclature
of pulses which is richer in variety and subtlety than that of the list of § 213.

A °e Bloom of life : pulse firm and full ; persons of nurture may show a
slow thini even soft, pulse, uniform at C, W, and G ; if not uniform, such a pulse
is a sign of shortness of life.

Old age : the pulse is slow and weak. Some old men have the pulse of long
life "—strong, firm, fairly swift, not skipping. (The presence of a skipping or
hesitating character would show that the strength of the person is outward, and
that life would not reach an extreme length.)

8. The Pulse in the Various Temperaments

579. Hot temperament. The resistance is great. If the
vital power and artery correspond, the pulse will be large. But
if one of them do not correspond, the pulse will vary in the manner
already described.

If the heat is not due to an intemperament, but is natural,
the vital power will be very strong, and the heat increases. But
one must not suppose that the increase of innate heat, to however

* Dukhani ; lit. smoke or mist.

THE CANON OF MEDICINE 311

great an extent, will lessen the vital power. For, on the contrary,
the power of the breath becomes greater, and the mental qualities
show more boldness.

If the heat arises from intemperament, the greater the
degree of heat, the greater the weakening of vital power.

Cold temperament. The pulse is reduced in breadth, and so
becomes small, slow and infrequent (sluggish). If the arteryis soft,
the pulse increases in width, and also becomes slow and infre-
quent. But if the artery be hard, the breadth will lessen. The
weakness produced by a cold intemperament is greater than that
produced by a hot intemperament because the heat of the latter,
for^ instance, is then more correspondent (i.e. in slowness or
activity) than is the innate heat.

Moist temperament. The pulse is here soft and wide.

Dry temperament. The pulse becomes hard and wiry.
If the vital power be strong and the resistance great, the pulse
will become dicrotic, or spasmodic, or thrilling.

These remarks will suffice in regard to the relation between
the several temperaments and the simple types of pulse. The
effect on composite pulses can be worked out from the principles
already explained.

580. It may happen that a person may have a dual tem-
perament, one side being cold and the other hot. The pulse will
then be different on the two sides, according to the heat and cold
respectively. In the one case it will be like the pulse in hot
temperament ; in the other like that in cold temperament.
From this we learn that the expansion and contraction of the
pulse is not merely an effect of the ebb and flow of cardiac action,
but there is also an expansion and contraction of the arterial
wall itself.

9. The Effect of the Seasons on the Pulse

581. Spring. The pulse is equable in all respects except
in strength, which is above the mean.

Summer. The pulse is quick and brisk, because of the re-
sistance. It is small and weak because the vital power is dispersed
by the dispersal of the breath (which in its turn is due to domin-
ance of undue external atmospheric heat).

Winter. The pulse is more sluggish, slow, weak, and
therefore small. This is because the vital power is lessened.
In some people the heat is retained interiorly and aggregated
together, thus making the vital power stronger. This is espec-
ially so if the temperament is hot, for then the external cold is

3 i2 THE CANON OF MEDICINE

overruled and prevented from passing inwardly, as would other-
wise occur. 1-1

Autumn. The pulse is unequal and tends to a certain weak-
ness. ~The inequality is due to the frequent changes of tem-
perament which occur during this season owing to the fluctu-
ations of temperature. The temperament is now hot, now cold
accordingly. The weakness is due to two causes : (a) a contrary
temperament always renders the injurious effect of a nocument
greater than a similar but equable temperament would, even
though that be a morbid one ; (b) autumn is a season antagonistic
to life because at this period the innate heat is lessened and dry-
ness dominates.

At periods between the seasons, the pulse corresponds to

the adjoining season.

The pulse at each season also has its own appropriate

rhythm.

§ 235. The following details from the Chinese work are tabulated for con-
venient survey : —

Month and Season.

Dominant

element

(Chinese name)

First

Spring

Second

Spring

Third

Fifth

Fourth

Summer

Fifth

Summer

Sixth

Fifth

Seventh

Autumn

Eighth

Autumn

Ninth

Fifth

Tenth

Winter

Eleventh

Winter

Twelfth

Fifth

t'u

huo

t'u

chin

t'u

shiu

t'u

Type of Pulse.

Tremulous : long.

Moderately slow : strong : hard.
Superficial : strong : " scattered.

Mod.' slow : strong : hard.
Superficial ; short ; brisk.

Mod. 'slow: strong: hard.
Deep : soft : slippery.

Mod. slow : strong : hard.

If the pulse proper to one season is met with during a different season this
is usually to be regarded as morbid, and may betoken a long or a short or a fatal
illness according to the particular inversion. The autumn type m spring ; the
winter type in summer ; the summer type in autumn, are grave signs

It is to be noted that the third, sixth, ninth, and twelfth months form a fifth
season, and are not counted under the corresponding season. These months there-
fore correspond to those named in Avicenna periods between the seasons The
pulse changes are definitely specified in the above table, though only spoken of
generally in the Canon.

10. The Effects of Locality on the Pulse

582. Some regions are temperate and vernal ; some are

hot and aestival ; some are cold and winterly ; some are dry

and autumnal. The character of the pulse will follow the

statements made in regard to seasonal influences upon the pulse.

THE CANON OF MEDICINE 3I3

ii. The' Effects of Food and Drink
583. Aliments (lit. substances entering the body from with-
out) alter the condition of the pulse according to their quality
and quantity, (a) By quality, one refers to the calefacient or
mirigidant nature of the substance in question, which has a
corresponding effect upon the pulse, (b) As regards quantity—
if the amount of aliment is moderate, the pulse shows an increase
of volume, swiftness and frequency, owing to the increase of
vital power and innate heat resulting ; this change in the pulse
lasts a considerable time.

If the amount be unduly great, the pulse will become
irregular and disorderly, because the burden of the food overrules
the vital power ; any overloading renders the pulse irregular.
Archigenes thought that the swiftness of the pulse exceeded
the frequency, as long as the excess of food existed. When the
excess came to be less, the pulse would show an orderlv irregu-
larity. J 6

If the amount be unduly small, the pulse becomes irregular
both in volume and swiftness. In this case the duration of the
change would be short because so small an amount of food
would be rapidly digested.

If the vital power is weakened, whether the amount of food
taken be small or large, the pulse corresponds in smallness and
slowness until the digestion of the meal is completed.

If the natural (vegetative, digestive, maturative) faculty be
strong, the pulse will be equable.

584. Effect of wine on the pulse. Wine has a notable effect
on the pulse, in that if taken plentifully, being attenuated in
nature, it gives rise to an irregular pulse,' but not to so great an
extent as other similarly nutrient aliments. This is because its
substance is too rare, attenuated, and light. Being in actuality
cold, wine,- like other cold things, lessens the pulse-rate and
makes it slow and infrequent in proportion to the rapidity with
which it enters the body. Once it has become warmed bv the
body the initial effect passes off.

The heating effect of zvine. The heating effect which wine
produces is not very different from that of the innate heat, for
wine is rapidly distributed through the body, especially if taken
warm, and _ it undergoes rapid dissipation or resolution. If
taken cold, it exerts an injurious effect on the pulse of a kind not
shared by other cold articles of food, for the latter become warm
only gradually and do not reach the blood as quickly as does

3 i 4 THE CANON OF MEDICINE

wine, and they are therefore warm when they do so. But
wine is absorbed so quickly that it has to be warmed by the
blood itself, and this constitutes a noxa for such persons as are
sensitive to cold. This injurious effect is not as great in degree
if the wine is taken warm, because the natural faculty then
counteracts it by breaking it up, distributing it through the body
and finally dispersing it.

The cooling ejject of wine. Wine has a cooling effect when
it causes the natural power to fail, so that the pulse loses its
strength before the wine has become broken up, distributed and

dispersed. . .

Such is the manner in which the use of wine in quantity

produces a heating or a cooling effect. _

585. When we study the question of how the use of wine
can make the pulse strong, other factors must be considered.
Its own intrinsic character invigorates healthy persons ; it
enhances the vital power by securing a rapid accession to the
" substance " of the breath.

Although the heating and cooling effects above explained
are injurious to most persons, there are some whose temperament
is suited bv it. Cold things, for instance, are tonic for persons of
hot intemperament. For, as Galen truly said, the juice of pome-
granate is strengthening for persons of hot intemperament ;
honey-wine is tonic for those of cold temperament. _

Wine may therefore be considered to be hot in nature, in
that it is tonic for persons of hot temperament ; cold in nature
in that it is tonic for those of cold temperament. Still, this
question is aside from our purpose. We are concerned with the
fact that is speedily accedes to the breath, as an intrinsic property ;
and that from that point of view it is always invigorating.

The pulse becomes stronger if either the invigorating effect
is exerted or the warming effect. It becomes weaker if neither
occurs. By warming the body the resistance [i.e. the blood-
pressure] is increased ; by cooling the body the resistance is
diminished. But the usual action is that the pulse becomes
stronger. Moreover, resistance [blood-pressure] is never in-
creased without rendering the pulse more swift.

588, Water. Water has a similar invigorating effect to
wine, because it is the means by which the aliment is enabled
to permeate all through the body. But as it induces cold
rather than warmth, it does not increase the resistance as much
as does wine.

THE CAN ON OF MEDICINE 315

12. The Effect of Sleep and the Act of Waking on the

Pulse

587. The characters of the pulse during sleep vary according
to the stage of sleep and the state of digestion.

At the_ beginning of sleep, the pulse is small and weak,
because the innate heat is then in process of retracting and with-
drawing inwardly,* instead of expanding and travelling to the
surface.

588. Difference between the " heat " in the first stage of
sleep and that produced by exercise. — During the time of sleep,
the innate heat is withdrawn inwards by the vegetative faculty
in order to procure the digestion of the aliment and the matura-
tion of effete substances. The heat is therefore, as it were,

■ mastered and forced into service. The pulse is therefore more
slow and sluggish in spite of the fact that the contraction and
imprisonment of the heat in this region means a local increase
of heat. For, in amount, this local heat is not so much as exists
during the waking state, with its associated movements and
exercise.

_ Thus, exercise .is apt to create undue heat and " inflam-
mation " up to an intemperamental degree, whereas there is
only z moderate aggregation of heat when the. innate heat is
imprisoned, and so " inflammation " is less feasible. You know
that this is so, because of the fact that exercise makes breathing
laboured (forced), and hurried, incomparably more than when the
innate heat is constricted and imprisoned by some other agent
similar to sleep. For instance, to be submerged in tepid water
brings about such an imprisonment of innate heat, and produces
rapid respiration, yet not nearly to the extent produced by toil
and exercise. Careful consideration shows that nothing increases
the heat as much as these do. But it is not the mere exercise
which accounts for this, as if resting would bring about a ces-
sation of heat production. It is rather that the heat produced
by exercise simply moves on the breath to the exterior parts,
as long as generation of the breath takes place.

589. During the stage of sleep following the completion
of digestion, the pulse becomes stronger. This is because vital
power is added to by the digested aliment. The heat which had
passed to the inward parts now returns towards the surface in
order to regulate the nutrients passing thither, and also returns
towards its source. This fact, and the fact that the temperament

* i.e., into the abdominal viscera, in whose veins the blood has now collected.

3 i6 THE CANON OF MEDICINE

is made hotter by the products of nutrition explains why the pulse
becomes of increased volume, and the arterial wall is softer
because of the addition of the" appropriate nutrients. There is
no increase in swiftness and briskness along with the increase
of volume, because mere increase of volume does not alter blood-
pressure (lit. increase the resistance) either directly or indirectly ;
that is, by restoring the factors which directly raise the blood-
pressure (lit. increase the resistance).
r * * *

The thought underlying this passage may be expressed as
follows : — The 'person is supposed to have gone to sleep shortly
after completing his meal. The body-heat is now concentrated
round the digestive organs in order to render digestion possible.
The surface of the body becomes cold. Later, when the first
digestion is accomplished, the products are distributed_ to the
various parts of the body. The heat now leaves the interior
parts (i.e. the splanchnic system), and may be pictured as
passing to the surface again, whence it had come (mabda'), so as
to be ready to receive these digestive-products. Once more
does it preside (lit. regulate, tadblr), or brood over them so as to
render possible the further (third and fourth) digestion which
they are about to undergo in this new situation.

The pulse is strengthened by two factors : (a) the access of
body-heat which has now left the abdomen ; (b) the food-products.
The latter affect the pulse in two ways : (i) indirectly, by making
the temperament more hot ; (ii) directly, by making the arterial

wall soft.

The person, it will be borne in mind, is supposed to be
still sleeping. If he continues to sleep, the pulse will change
in the manner next to be described ; if he awakes, the conditions

also change, and the pulse alters as described below.

* * *

590. If sleep continues after the completion of digestion,
the pulse again becomes weak owing to the aggregation of innate
heat and the choking of the vital power by the undue prepon-
derance of those effete substances which now await evacuation by
channels only possible during the waking state — namely exercise,
and the insensible perspiration.

591. If the body were fasting when sleep began, and there
is nothing awaiting digestion, the temperament would tend to-
wards coldness, and consequently the pulse would not only
remain small, slow and sluggish but would become more so.

592. The act of waking has certain effects on the pulse.

THE CANON OF MEDICINE 3n

When a sleeping person awakes, the pulse steadily gains volume
and swiftness until it "reaches the natural state fVthat person.
But if the^ wakening is sudden, the change in the pulse will be
sudden ; it will become rapidly weak, because the act of waking
overrules the vital power. The previous large volume will
reappear later, and the pulse will become quick, brisk and
irregular (up to "thrilling"). The quasi-violent movement
introduces great heat. The sudden stirring up of the vital power
to meet the sudden change accounts for the irregularity and
trembling of the pulse. _ However, the pulse does not remain
long m this condition ; it rapidly becomes regular again.
Seemingly potent though the agent 'is, its duration is so short
that all trace of its effect is soon lost.

13. The Pulse during (rigorous) Athletic Exercise

Note : the word " Exercise " includes (a) athletic sports of all kinds : running
endurance tests, sprinting, gymnastics of all kinds, military exercises, laborious
manual or physical work ; (b) work in the fields ; (c) necessary exercise and walking
exercise taken for health's sake and recreation ; (d) mental.

593. _ At the outset, as long as the exertion is moderate,
the pulse is large and strong. This is because the innate heat
increases, and is strong. The pulse is also swift and brisk. This
is because the resistance becomes greatly increased by the
exertion.

(The pulse is frequent, strong, and the artery is moderately contracted : 115 )

594. As exertion continues and increases, even if it be
intense for only a short time, the pulse weakens, and, with the
dispersal of the innate heat, becomes small. The pulse remains
swift and brisk for two reasons : (1) the degree of resistance
(i.e. blood-pressure) is further increased ; (2) the vital power
progressively fails until it is insufficient. After this, the swiftness
steadily and progressively lessens ; and the briskness increases
correspondingly to the lessening of vital power.

(Violent, but not excessive exercise, renders the pulse frequent, strong sudden
vehement, large, short, dicrotous : * 1 5 )

Still further prolongation of the exertion weakens the. pulse
until it becomes formicant and very brisk.

(Exhaustion produces a frequent, sudden, short, not vehement, very dicrotous
pulse. It is large unless the heart is very weak. Fatigue makes the pulse slightly
slow; the force is diminished, the arteries are relaxed. 115 )

595. Finally, if the exercise has been carried on to an
extremely excessive extent, it leads to a state akin to death, acting

3 i 8 THE CANON OF MEDICINE

like all resolvents— that is, it renders the pulse vermicular, very

brisk, slow, weak and small.^

14. The Effect of Bathing on the Pulse

596, (1) Hot bath. If one bathes in hot water, the first
effect is to make the pulse strong and raise the pressure. When
the bath has brought about a dispersal of the vital power, the
pulse becomes weak. Galen says it is small, slow m beat and
sluggish. But while agreeing that it is weak and small ; we
say that the hot water acts first by increasing the interior heat
of the body, like any extraneous heat, i.e. only temporarily.
After a while the water resumes its cooling effect* — its natural
quality. This cooling effect may persist. As long as its action
as extraneous heat holds the field, the pulse becomes swift and
brisk. But when its own natural character is resumed, the pulse
will be slow and sluggish. If the incidental quality (of being hot)
lead to so much loss of strength that syncope is imminent, the
pulse becomes slow and sluggish.

(2) Cold baths. If the cold reaches to the interior parts,
the pulse becomes weak, small, sluggish, slow. If it does not do
so but has the effect of aggregating the innate heat in the
interior, the volume of the pulse will increase as the power
increases, and the swiftness and briskness decrease.

(3^ Bathing in natural thermal waters. If these have desiccant
properties, the pulse becomes harder and its volume diminishes
If they impart warmth, the swiftness increases. _ If they dispel
the vital power the pulse will come to be as described above.

15. The Pulse in Pregnancy

597. The resistance is specially great in pregnancy, because
the foetus shares in the mother's respiration. Both mother and
embryo have their own resistance (blood-pressure), and there is
as it were a double respiration. Nevertheless there is no doubt
about the fact that the vital power is neither increased nor
lessened, except to a degree consistent with a slight lassitude
proceeding from the mere weight of the foetus. Hence the in-
crease of resistance overrules the moderate amount of vital
power, and the pulse is made of greater volume and becomes
swift and brisk.

8 «6 The Chinese say : a pulse at C which is constantly superficial (or
" swimming "for deep in an Otherwise healthy woman, with arneuorrho^, b<^
pregnancy? so also a high strong C pulse ; a slippery pulse at C is a certain

* On the nervous system.

THE CANON OF MEDICINE 319

sign. An overflowing and high or deep and full pulse at the left C goes with a male
pregnancy ; a superficial and high pulse at the right C betokens a female pregnancy.

A number of other rules are given, the changes in the character of the pulse
during the successive months of pregnancy being specified. Thus, first month :
W pulse small, C pulse brisk. Third month : pressure with the finger makes the
pulse seem to disperse. Sixth month : pressure does not alter the typical character.
Seventh-eighth month : full, hard, strong pulse betokens a good labour. A deep
and slender pulse forewarns of difficult labour.

Death of the foetus makes the pulse long and tremulous.

If the C pulse is continually small, weak, and sharp, and the nature is cold, \
with a tendency to shiverings, pregnancy will never be possible.

16. The Pulse in Pain

598 e Pain changes the character of the pulse according to
(1) its intensity ; (2^ its duration ; (3) its situation — whether
the member affected is a vital one or not.

At first, pain stirs up the vital power, making it resist and
counteract the pain ; at the same time the cause of the pain
increases the heat of the body. The pulse is therefore of large
volume, swift and very brisk, the effort entailed in immobilizing
the body [the reflex effect of the pain] accounting for the volume
and swiftness. When the pain becomes less unbearable in one
or other of the ways we have already explained, the pulse steadily
declines in fullness until it has lost its size and swiftness ; but
these features are replaced by very marked briskness and small-
ness of beat, and hence the pulse becomes formicant and ver-
micular.

If pain becomes more and more severe, it makes the pulse
sluggish and finally extinct.

17. The Pulse in (Inflammatory) Swellings

599. The formation of certain swellings is associated with
fever, either because of their size, or because they affect some
vital organ. The pulse varies with the changes induced in the
body as a whole by the fever, as we shall explain in its proper
place.

Afebrile swellings alter the pulse of the member itself, from
their very nature. The pulse in the rest of the. body may be
altered secondarily — not because they are swellings, but because
they produce pain (and restrict movement. Aeg.).

In sthenic fever, the pulse is frequent, sudden, vehement, large, short,
dicrotous. In asthenic fever it is frequent, sudden, not vehement, large (unless the
heart is weak), short, and very dicrotous. In peritonitis, the arteries are extremely
contracted. (Broadbent.)

600. When an inflammatory mass causes a change of the
pulse, it does so either according to (1) kind of swelling, (2) its

3 2o THE CANON OF MEDICINE

phase, (3) its bulk, (4) the organ in which it occurs, (5) associated

effects. .,,,,,

1. Relation to variety of mass, {a) If ' hot,_ the pulse
becomes harsh, and coarsely, and then finely thrilling ; swift,
brisk. (b) If, however, there is an antagonistic humectant agent
at work, the pulse ceases to be harsh and becomes undulatory.
It is also always tremulous — coarse or fine tremor — and swift
and brisk. Not only are there agents which will alter a hard
pulse,' but there are also agents which make a harsh pulse more
decided, (c) If the mass be soft, the pulse is undulatory.
(d) If very cold, the pulse becomes slow and sluggish, (e) If
hard, the harsh pulse becomes still more harsh.

When abscess formation comes on, the pulse ceases to be
harsh and becomes undulatory. This is because suppuration
goes with moisture and softness. The pulse also becomes
irregular owing to the weight of the mass, and the rate of brisk-
ness lessens owing- to the" fact that heat-formation ceases with
maturation of the pus.

2. Relation between phase of inflammatory process and
character of pulse. The larger the " hot " inflammatory mass
becomes, the more harsh does the pulse become. The hardness
and tension in the mass increases steadily, and as the pain in-
creases, tremor appears in the pulse. At the acme, all the
features of the pulse become more marked, except those depend-
ing on force ; the force of the pulse lessens and the briskness
and swiftness increase. If the acme is prolonged, the swiftness
lessens and the pulse becomes formicant. After the swelling
subsides, whether by natural processes or by surgical interference,
the pulse becomes strong in proportion as the tension in the
swelling lessens ; and the pulse ceases to be thrilling because
the pain ceases with the fall of tension in the tissues.

3. Relation between bulk of inflammatory ^ mass and the
pulse. A large mass denotes marked inflammation ; the pulse
becomes larger in all respects, and each beat is prolonged.
When the mass is only small, the pulse is smaller and more

sluggish.

4. Effect of the position in the body. When the inflam-
matory process is situate in an organ or tissue rich in sensory-
nerves, the pulse' becomes hard, and approaches the "harsh"
type. If the organ is rich in blood-vessels, there is an increase
in size of the pulse, and in force ; and it is very irregular. If
arteries predominate — as in the spleen and lung — the volume
is not maintained unless the force is maintained as well.

THE CANON OF MEDICINE 321

When it is situate in moist soft members (like the brain
and lung) the pulse becomes undulating.

5. Effect of secondary results of inflammation. An inflam-
matory mass in the lung has a choking effect, and hence the pulse
becomes thrilling • in the liver, atrophy is produced and the
pulse becomes like that found in wasting diseases ; in the kidney,
strangury is produced, and there is suppression of urine, which
alters the pulse accordingly. In members which are rich in
sensory nerves (stomach, diaphragm), the pulse becomes
spasmodic and swooning.

18. Effect of various Emotional States* on the Pulse

601. Anger. Anger stirs up the vital power and causes
the breath (ruh) to expand all at once. Hence the pulse is large,
rises high, is swift and brisk. It is not necessarily irregular
because the passion does not change — unless there is fear present
as well, in which case anger would prevail at one time, and fear
at another. Irregularity may also occur if shame is associated,
for the intellect warns the person to be silent and not yield to
the same evil as did the person who has excited one to anger.

Excitement apart from anger.— The pulse is frequent, strong, and the artery
is moderately contracted. — Note also the modern observation that " excitement
always increases the blood-concentration, sometimes by as much as 10 per cent ""
(Barbour and Hamilton, Journ. Am. Med. Assoc, 1927, p. 91).

Delight. Here the movement is gradual and outwards.
The pulse does not become as speedy and brisk as in the case of
anger, but its volume is adequate for the resistance, and therefore
the pulse is slow and infrequent.

Joy. The pulse is similar to the preceding, because usually
large in volume, and soft ; it becomes slow and infrequent.

Grief. Here the heat is extinguished, or choked, nearly to
obliteration, and the vital power is weakened. Hence the pulse
is small, weak, sluggish and slow.

Fear. If of sudden origin, the pulse becomes quick,
irregular, disorderly. If the state is prolonged, or more or less
habitual, having begun insidiously, the pulse varies with the
varying shades of anxiety.

Love.— " Now the lover's pulse is variable and irregular, especially when he
sees the object of his affections, or hears her name, or gets tidings of her. In this
way one can discover, in the case of the one who conceals his love and the name of
his beloved, who is the object of his passion. . . ."— (Dhakhira-i-Khwarazm-shahi,
Book vi. Guftar 1, Juz' 2, ch. 3 ; E. G. Browne's translation,' p. 89.)

* Nafsaniat. See § 160 hi, iv, and 174 sqq.

322 THE CANON OF MEDICINE

19. Brief Summary of the Changes produced by Agents

ANTAGONISTIC TO THE NATURE OF THE PuLSE

602. When the pulse is changed by such agents, it is
either (1) because of an intemperament ; and you know the effect
of each of these upon the pulse ; or (2) by confining the vital
power, whereby the pulse becomes irregular. If the restriction
be unduly great, the pulse becomes also disorderly and arhythmic
The degree of confinement varies with the amount of morbid
material, whether there be an inflammatory mass or not. Or,
(3) b y dispersal of the vital power, whereby the pulse becomes
weak. Here belong such agents as : severe pain, affections of
the mind which produce a profound loss of vital power, severe
or protracted diarrhoea.

8 2^7 Pulse in convalescence from acute disease : the rate is normal or slightly
slow -the force of the heart is diminished and the arteries are relaxed The force
of the heart and the arterial tone increase as convalescence advances. (Broadbent,

P ' 5I The " renal pulse " : the frequency is normal or slightly diminished. The
force of the heart beat is increased. The arterioles are contracted (ib.).

THE URINE

i. General Remarks

Precautions necessary in Collecting the Urine, before
Forming an Opinion as to its Character

603. i. It must be collected in the early morning* ; it
must not have been kept over from the night before.f

2. The person must not have taken either food or drink
before passing it.

3. _ The previous food must have been free from colouring
agents like crocus and cassia fistula (these render the urine lemon
yellow or ruddy), and from potherbs (which make the urine a
greenish tint), and from salted fish (which renders the urine dark),
and from intoxicating wines (which tend to render the colour
of the urine similar to themselves).

4. The patient should not have been given an agent which
expels some humour (a cholagogue or phlegmagogue) by the
urine.

5. Physiological state. The patient should not have under-
taken severe exercise or toil, or be in a praeternatural mental
state ; for in each case the colour of the urine may alter. E.g.,
fasting, wakefulness,f toil, anger, dread — for all these cause the
urine to become more lemon-yellow or redder in tint. Coitus
also alters the urine, rendering it oily. Vomiting and defecation
alter both colour and texture of the urine. The same happens
if the urine is kept standing a while. This is why some advise
urine not to be left standing more than six hours before exam-
ination, for otherwise the significance is altered ; the colour
changes; the sediment goes partly into solution ; and the
density increases. Personally I think that such changes begin
within an hour.

6. The whole of the urine should be collected into one

* Because digestion, whose efficacy the urinoscopy determines, will then have
had time to be completed in a normal person.

f The patient must have slept through the night.

323

324 THE CANON OF MEDICINE

single vessel lest anything should be spilt out of it ; one should
allow it to settle before scrutinizing it.

7. The urinal must be clean. For instance, alkanna will
impart its colour to the urine ; this is a dye used by some
people for tinting their skin and finger-nails.

8.. The vessel used for the specimen must be clean, and
the previous sample must have been rinsed out of it.

9. The material of which the vessel is made should be
clear white glass or crystal.

10. The urine must not be exposed to the sun or wind
or freezing cold, until the sediment has separated out and the
various characters have properly developed. The settling is not
immediate even if the digestive processes are normal.

11. The sample must be inspected in a light place where
the rays do not fall directly upon it, as otherwise the brilliant
light would interfere with the colours and give rise to erroneous
deductions.

12. The nearer one holds the sample to the eye, the denser
does it appear. The further away it is, the clearer does it seem.
In this way one can distinguish urine from other fluids brought
to the doctor in a falsified state.

604„ There is little advantage to be derived from the study
of the urine in childhood, and still less in infancy, because their
nourishment consists solely of milk, and the very little colouring
matter there is in the urine is lost to view ; their " nature " is
also very feeble in view of the fact that they pass so much time
in sleep, which abolishes the evidences of digestion.

805o The first and foremost object of observing the urine
is to form an opinion about the state of the liver, the urinary
passages and the blood-vessels. The various disorders of these
organs are revealed by it. But the most precise information
to be obtained is that concerning the functional capacity of the
liver.

Inspection of Urine, (tafsira.)

The name " tafsira " is given to " inspection " because it " explains " (tufassir)
and makes manifest to the physician ; it is an indication or guide (dalll) to the
patient's condition.*

606, The following are the points to observe in a
sample of urine :

1. quantity (665)

2. odour (645)

* Diet, of the Technical Terms used in the Sciences of the Mussulmans 1I8 , and
Browne ', p. 142.

THE CANON OF MEDICINE 325

3. colour • (609)

4. foam (649)

5. texture (627) :

6. clearness (632)

7. sediment (652)

Some persons add other two : the feel and the taste, but
we reject them as objectionable.

By colour we understand the various shades of colour
perceived by the sense of sight — whiteness, darkness, inter-
mediate shades.

By texture we refer to the coarseness or fineness.

By clearness or turbidity we refer to the ease or otherwise
with which light traverses it (translucence).

607. There is a difference between texture and trans-
lucence, for a urine may be coarse and yet as .clear as egg-white
or liquid fish-glue ; and a rarefied urine may be turbid (e.g.
turbid water is more rarefied than white of egg).

608. Turbidity depends on the presence of certain vari-
ously coloured particles — opaque or dark, or tinted with other
colours which are imperceptible to the sense of sight and yet are
impervious. Sediment differs from turbidity in that the particles
are readily visible to the eye, whereas particles cannot reallv be
distinguished in the case of turbidity. Sediment appears imme-
diately after the passage of the urine ; turbidity does not clear
up on standing. Turbidity differs from coloration in that the
latter pervades the whole substance of the urine, whereas tur-
bidity is less intimately admixed.

1. The Significance of the Colour of the Urine

609o The degrees of yellowness. Among the shades
of yellow colour are : (1) straw-yellow ; (2) lemon-yellow;*
{3) orange-yellow ; (4) flame-yellow, or saffron-yellow ; that
is, a very deep yellow ; (5) clear reddish-yellow. All except
the first two denote a hot in temperament, in degrees varying
with the amount of exercise, pain, fasting, and abstinence from
water. The fourth variety denotes predominance of the bilious
humour.

[Variants of (i). If the urine is plentiful also, it shows that a crude humour
is being excreted by the urine. If there is also a sediment which is white, smooth,

* Lemon-yellow (utruj). — Orange-yellow (narahja). — Reddish-yellow (shuqrat).
— The latter is the yellowish colour of a chestnut horse. — Another yellow, with a
areddish shade, is called jujube colour (unnabi) ; this is not in the text, though
■enumerated with dyers' colours (cf. Night 933).

326 THE CANON OF MEDICINE

equable and plentiful, it shows that the digestion is good. If thicker, and a sediment
is present, it shows that the digestion is not altogether bad. If gritty, scaly, fur-
furaceous, with black, livid, green or fetid sediment, this shows entire lack of diges-
tive function (Aegineta).] : -

610. II. The degrees of redness, (i) rose-red or roseate ;
(2) very dark red ; (3) purple red, which has a brilliance about
it like a certain rose ; (4) smoky red or dull red. All these
denote dominance of the sanguineous humour, for dullness,
of colour points that way. A flame-yellow shows the presence
of more " heat " than dull red because it shows there is bilious
humour in it, and this is hotter than sanguineous humour.

The urine tends to saffron-yellow and flame-yellow in acute
maladies described as " burning " ; but if the urine is at all
inclined to be clear, it shows a certain degree of " digestion,"
namely that this process has actually begun, but its products
have not yet appeared in the substance of the urine.

611. ' Deepening of colour from lemon-yellowness towards
a flame-yellow shade shows that the innate heat is steadily-
increasing. The colour then ceases to be yellow, and attains a
pure clear red. If the urine now begins to clarify it shows that
the (pathological) heat is beginning to subside.

In acute diseases of a haemorrhagic character, the urine
may be tinged with blood without any evident rupture of blood-
vessels having occurred. This would indicate an _ excessive
plethora. A gradual loss of blood by the urine, associated with
a bad odour, is a sign to be dreaded because it informs us that
there is haemorrhage proceeding from congested parts. The
prognosis is still worse if the urine becomes thinner and more
offensive in odour.

612. Admixture of the urine with blood may be a good
sign — namely in acute composite fevers — for it shows that
crisis is about to take place, and recovery will follow. The only
exception is if the urine becomes suddenly transparent (its colour
becoming normal, i.e.) before the crisis is due. Such a phenome-
non would be a forerunner of a relapse. But thin urine appearing
before the crisis may be equally unfavourable unless the change,
has been gradual and progressive.

613. In jaundice, if the urine becomes of a deeper red
until it is nearly black, and its stain on linen can no longer be
removed, it is a good sign ; — the better the deeper the_ red..
But if the urine becomes white or slightly reddish, and the jaun-
dice is not subsiding, the advent of dropsy is to be feared.

Fasting is among the conditions which render the urine-
high-coloured and of marked acridity.

THE CANON OF MEDICINE 327

614. III. The degrees of green colour, (i) A colour
approaching that of pistachios* ; (2) the colour of verdigris ;
(3) rainbow green ; (4) emerald green ; (5) leek-green. The
first denotes a cold intemperament, as do all things the shade
of whose green is not (2) or (5). These (2, c) denote extreme
combustion, but (5) is not as unhealthy as (2). If it should be
met with after- physical labour it denotes " spasm." A green-
coloured urine in adolescence points to the same condition.

Rainbow green usually denotes an extremely cold intem-
perament. In this respect it comes next to (1). Some say
that it shows that poison was present in the fluid taken as drink,
and that if there be a sediment present there is a hope of recovery;
if no sediment, death is likely to take place. Verdigris green
colour of urine forewarns of death (destruction of innate heat).

615. IV. The degrees of blackness. (1) Dark urine ap-
proaching blackness, through a saffron colour. This occurs in
jaundice, for instance. It denotes (a) denseness and oxidation of
the bilious humour ; (b) atrabilious humour derived from
bilious humour ; (c) jaundice. (2) Deep-brown-black. This
shows the presence of sanguineous atrabilious humour. (3)
Greenish-black. This shows the dominance of pure atrabilious
humour.

(Speaking generally) dark or black urine denotes (a) extreme
oxidation ; (J?) great cold ; (c) extinction of the innate heat
(i.e. death) ; {d) crisis ; (e) evacuation whereby the effete sub-
stances from the atrabilious humour are expelled.

616. (The details about each of these are :) (a) dark urine
due to extreme oxidation is recognized by its causing scalding, and
being previously yellow or red. The sediment is discrete (not
coherent), not homogeneous, discontinuous, not very dark,
but tending to a saffron, lemon-yellow, or dark brown." If the
colour of the sediment tends to be lemon-yellow, it strongly
suggests jaundice.

(b) When darkness of the urine is due to great cold, the
urine would previously be tending to a green tint or a livid tint.
The sediment is here slightly coherent, and looks dry, and is
more purely black in colour. If a dark urine is also very offensive,
it shows that the temperament is hot. If it be odourless, or has
only a slight odour, it shows that the temperament is cold. This
is because no odour emanates from urine unless the innate heat
overrules the cold.

* Cf. the passage in Night 933 : " I can dye various kinds of green, such
as grass green, olive green, pistachio green, parrot green." (Burton, v. 483.)

328 THE CANON OF MEDICINE

(d) When the darkness arises from a critical change in a tever
(" critical polyuria") one of the following conditions may be
supposed : the termination of a quartan fever ; the resolution
of a splenic disease ; the termination of a fever associated with
the atrabilious humour ; the termination of a fever prevailing
by night and by day ; subsidence of pains m the back and
womb ; retained menses ; retained blood in a case of piles—both
the latter two occurring especially when nature is assisted by art.
It occurs in women in whom the menses are retained, because the
effete matters of the blood cannot be disposed of by nature This
is shown in the urine by its being watery previously. VV hen the
effete matters are finally discharged from the body, the urine at
the same time becomes very abundant. ^

617 Prognosis. If at the critical periods the urine do not
become dark, it is an ominous sign, especially in_ acute diseases
the more so if at the same time (a) the quantity ol urine be small
(for scanty urine is evidence that the humour has already become
destroyed by oxidation) ; (b) the sediment be coarse-textured ;
the coarser, the more depraved ; the finer, the less.

Dark urine is a good sign in acute diseases. _ _

If the urine is limpid [as well as dark] and a deposit is
suspended in it at different layers, this denotes cephalalgia, wake-
fulness, deafness, mental confusion. If the urine is secreted
only by drops, and a sediment forms slowly, and the odour is
pungent, and there is fever— all this would be strong evidence
of the above. But when there is wakefulness, deafness, delirium,
and headache— such-urine would show that epistaxis is pending.

Dark or dull red urine which is passed after drinking wine
of that colour or after taking certain medicines need cause no
alarm. The wine has simply passed unchanged through the

° Dark urine may be evidence of renal calculus. As Rufus
says " black urine is good in infirmities of the kidneys and in
stone in the bladder, and also in maniacal cases, for they are
diseases proceeding from gross humours. But it is a grave sign
in acute diseases": On the other hand, he says that blacK urine
is a bad sign in diseases of the kidneys and bladder if at the same
time it is extremely scalding. Therefore one must take all such
signs into consideration. . .

When dark urine occurs in aged persons, it is not a good
sign because in such persons, as you know, it can only denote

THE CANON OF MEDICINE 329

great destruction oftissue. In puerperal women, the appearance
of dark urine is premonitory in convulsions.

In brief, the appearance of dark urine is serious at the onset
of fevers as well as at their close, if there is neither crisis nor any
abatement of symptoms at the same time.

618. White urine. The word " whiteness " is applied
in two ways : mere translucence, as the laity calls anything which
is translucent " white." Thus, clear glass, clear crystal, are
" white." Translucence implies absence of all colour. Such
urine is " thin " and translucent. Secondly, there is true white-
ness, like that of milk or parchment. Such urine is not trans-
lucent.

Whiteness in the first sense shows that the intemperament
is altogether a cold one, and that digestion is good. If the urine
be at the same time coarse, it shows that the serous humour is
abundant. A urine which is white in the second sense is neces-
sarilv coarse.
'619.

Variety of Whiteness.

(a) Mucilaginous.

(b) Waxlike.

(d) Musty whiteness :

(i) Tinted with blood and pus.

(ii) Not tinted with blood.

(e) Semen-like :

(i) Critical in form.

(ii) Not critical in form and no
inflammation.

(iii) Continuous throughout a fever.
{/) Lead-white ; no sediment.
(g) Milk-white ; in acute diseases.
(h) Previously coloured ; in acute fevers.

(i) Sudden change from red to white in
the course of a fever.

(j) Whiteness persisting in a person ap-
parently healthy.

(k) Whiteness like buttermilk, in acute
fevers.

Significance.

Excess of serous humour, and crude

humour.
Liquefaction of adipose tissue.
Liquefaction of serous humour ; or it

may denote diabetes, active or latent.

Ulcers discharging into the urinary

passages.
Great excess of crude non-matured

matter ; vesical calculus.

Crisis in an inflammation arising in

serous humour.
Diseases associated with vitreous serous

humour.
Seminal emission.
Forewarns of apoplexy and palsy.

The fever will soon become quartan

Bad.

Ominous.

This shows that bilious humour has
descended to some member about to
develop an inflammation (e.g., the
abdomen, or, which is worse, the head) .

The patient will become delirious.

Absence of digestion (esp. in the venous
system : Ch.M.') ; and in diabetes.
Fatal issue ; or wasting.

620. When the intemperament is hot because of the
dominance of the bilious humour, the urine may appear white

33 o THE CANON OF MEDICINE

[contrary to expectation]. When the intemperament is cold
because of dominance of ,the serous humour, the urine may
appear red [contrary to expectation]. If the bilious humour
passes down the urinary passages without being admixed with
the urine, the latter remains white. Hence it is necessary to
study white urine with care. For, if its colour were brilliant,
and 'if the deposit is plentiful and coarse, and the urine itself is
rather thick, it shows that the whiteness arises from a cold
intemperament, with predominance of the serous humour.
Again, if the urine be not clear and bright, and there is not much
deposit, and if the whiteness tends to a brownish tint, it shows
that there is bilious humour concealed therein. Whiteness in
the course of an acute disease, the signs of recovery being
present, with no fear of maniacal delirium, and the like, indicates
that the bilious humour has passed outby some other channel,
such as the intestine, causing constipation.

Brilliant.— Arabic ; mushriq ; Latin: clarus.— This term
describes the colour-effect produced in urine by the presence ot
bile-pigment (as shown by its use in the next paragraph, where it
is evidently equivalent to our " dichroic "). Other equivalents are :
bright, shining, refulgent, lustrous, luminous. In this passage
Avicenna seeks to warn the reader that a urine is not necessarily
free of " bilious humour " because it happens to be very pale (white).

Brilliance, however, may be taken as evidence of health, tor
when metabolism proceeds quite normally, the urine assumes a
peculiar clear shining colour when viewed in the light. In this case,
we may think of the various stages of catabolism proceeding without
the formation of irregular intermediate substances, or by-products.
The moments of nascence (§91) are " sharp " throughout.

621 If urine is red in the course of " cold " maladies,
it means'one of four things— (1) that there is severe pain which
disperses the bilious humour (ex. : colic without the signs ot
inflammation) ; (2) there is so much serous humour in the
bileducts as to give rise to obstruction there, and the bilious
humour is in conseqiience diverted from the intestine into the
urinary passages. (3) Hepatic insufficiency, especially m regard
to separating off water from the blood, as occurs in cold
dropsy. The urine comes to look like the washings of raw meat.
(A Some form of putrefactive process in the veins subsequent
to obstruction in the ducts ; here the serous humour in the
vessels undergoes a change of colour. The urine is rendered
watery, and the sediment is of a kind already described-
faint in colour, and not refulgent. _ The presence ot bilious
humour renders a colour refulgent (i.e. dichroic).

THE CANON OF MEDICINE 33 t

622. Urine is often white at the onset of a disease, and
becomes dark and offensive in odour later. So it is in jaundice.

623. Urine becomes White after a meal, and remains so
until digestion is nearly completed. It then begins to assume
colour.

624. During the waking state, the urine is white—partly
because of dispersal of the innate heat — but it is not refulgent.
It tends to be dusky if there is an associated defective digestion.

625. Prognosis. A red colour is better than ' a watery-
white one, in the case of acute diseases. But a white colour 'is
better if intrinsic — not due to wateriness.

Redness due to blood is not as dangerous as redness due
to bilious humour. Redness from bilious humour is not as
serious if the bilious humour is quiescent ; it is very ominous
if it begins to move about.

Red urine is very bad in the case of renal disease because it
is a sign that there is a " hot " inflammatory process there. If
it occurs m diseases associated with (intense) headache, it por-
tends delirium.

When a urine begins to turn red in an acute disease, and
stays so,_ without forming a sediment, it is an ominous sign
because it points to an inflammatory swelling in the kidneys.
If such urine becomes turbid, and stays so, it points to an inflam-
matory mass in the liver, with lack of innate heat.

Unusual coloration of the urine, produced by eating saffron or cassia fistula
must be borne m mind ; tricksters may alter their urine thus ( Alsaharavius) .

So much for the simple colours of the urine.

626. The compound colours of the urine.

(i) Like raw meat washings (i.e. blood-stained water).
This means hepatic insufficiency due to plethora of blood or
to any form of intemperament, resulting in deficient digestive
power and dispersal of the vitality. Were the vital power
adequate, it would show that there is plenty of blood, even to
great excess ; and in such a case, the secretory power would be
hardly adequate for dealing with it.

(2) Oleaginous. Oily. The fat of the bodv is being destroyed.
The appearance is like a lemon-yellow tinged with" the green-
ness of the mistletoe growing on larches. It is called oleaginous
because it is viscid and translucent, and also has the lustre of fat,
and shows a certain brilliance or refulgence in spite of a certain
opacity. It is not a good sign in many states, "not to say it is
bad. For it shows there is neither maturation, nor a change for

332 THE CANON OF MEDICINE

the better. In rare cases it indicates the critical evacuation of
unctuous matter, but for it to mean this alleviation must follow.
If such urine be also fetid and scanty m amount, it is a very
ominous sign. It is also serious if it be admixed with material
like meat washings, as might happen in the course -of dropsy,
phthisis, .and intestinal obstruction. ... , .

If oleaginous urine replaces a black urine, it is a good sign.
But if such a urine appear on the fourth day of an acute disease
it forewarns of the patient's death on the seventh day. (\ery
dark oily urine forewarns of collapse and death. Theophilus)

< In brief, there are three kinds of oleaginous urine (i) All
fat, throughout. (2) Fat only in the lower part (3) Fat m the
upper layers. The first is oleaginous only in colour ; it occurs
in phthisis, hectic fever, and wasting diseases, especially at their
outset The second is oleaginous only in substance. itie
third is oily in both respects— e.g. m diseases or the kidney,
at the acme and termination of phthisis.

h) Purple {-black). This is a very bad sign. It means
oxidation of both bilious and atrabilious humour

(a) Ruddy colour admixed 'with a tinge of blackness. 1 ius
occurs in composite fevers and in fevers arising from gross
superfluities. If it clarifies, and the darkness settles down from
the surface, it denotes an inflammatory .mass in the lung.

3. The Signs afforded by the Density^ Quality, Clearness
or Turbidity of the Urine
627. Urine may be tiansparent or opaque, or intermediate
in density.

T , c .. Hp „ itv » h e r e spoken of is not the equivalent of "specific
gr av^/ ?7 thouJh many "f 4e sSemTnts in the text would apply equally even m
the modern sense. , h the morning and evening urine

I need for depurative foods (greens, acid fruits).

TRANSPARENT (LIMPID) URINE

628 Whatever be the state, a urine of limpid consistence
denotes : (a) deficient digestion (lack of maturation) ; {p)
venous congestion ; (0 renal insufficiency (for the kidneys
Inly separate, out fine matter, or if they attract other matter,
they fail to discharge it until it has been rarefied or rendered capa-
ble 7 of excretion ; \d) excessive fluid-intake ; (e) a very cold or
a dry intern perament.

THE CANON OF MEDICINE 233

When it occurs in the course of an acute illness, it denotes
deficient digestive power, . and inability to complete digestion
(absence of maturation : cf. above). It may indicate that the
weakness of the other faculties is so marked that they cannot
influence water at all, and hence it passes through the body
unchanged.

629. Prognosis. It is worse for urine to be very transparent
at puberty than in adolescence, because during the former period
of life urine is naturally more opaque than in adolescence. Being
more moist in their temperament, their bodies attract moisture
more readily, and, in addition, moisture is essential for their
growth. Hence, if acute fevers arise during the age of puberty,
the urine is decidedly abnormal if it is transparent ; and, should
it continue of that character, it would be a very ominous sign.
Should it continue and favourable symptoms should not appear,
and should the vitality not be maintained, it would be a sign
that an abscess is forming below the liver.

630. If urine continue to be transparent for a long time
without any variation in a person otherwise healthy, should he
experience pain one will know that an inflammatory mass is
forming in the situation of the pain. The pain is usually lumbar
when the urine is of this character, and that is the usual site for
an abscess.

If there is no localized pain in such a case, but a general
pain and heaviness, this points to the widespread formation of
small pustules.

If the urine is transparent at the crisis of an illness, contrary
to rule, it forewarns of a relapse.

OPAQUE (THICK) URINE

831. If the. urine is very opaque, it shows that maturation
has failed to take place ; or, more rarely, it denotes the matura-
tion of " gross " humours, such as occur at the height (status)
of humoral fevers, or after the opening of abscesses. In acute
fevers, the appearance of opaque urine is usually a bad sign,
though not as bad as a persistently transparent urine. The fact
that urine is opaque shows that there is a certain degree of diges-
tion proceeding, because digestion adds to the opacity of urine
to a certain extent, and shows that there is some power of expul-
sion (of effete matter). But it is a bad sign in so far as it denotes
the breakdown of, and abundance of, humours, and that the
evacuation of the separated materials is hindered.

334 THE CANON OF MEDICINE

To ascertain which of the two is dominant, notice whether
improvement or increased weakness follows.

Prognosis. When opaque' urine is passed in the course
of fevers, it is a less serious sign if it be poured out quickly and
plentifully. When excreted slowly it denotes a redundance of
the (serous, Ch.M. 7 ) humours and an enfeebled vitality. A sign
which is still less serious is that a urine of medium density should
go with a simultaneous improvement in the general condition.

A very dense urine sometimes denotes that digestion is unduly excessive
(Ch. M.').

When the urine is transparent in an acute illness, and then
becomes thick, and there is no improvement in the condition of
the patient, it denotes colliquation [of tissues].

Persistent opacity of urine in a presumably healthy person
forewarns of fever should headache and mental confusion arise.
Opaque urine also occurs after excessive evacuations, after the
opening of an abscess, or owing to ulcers in the urinary passages.

Transparent and opaque urine cannot both denote lack of
digestion (maturation) unless there is an intermediate degree of
density associated with the maturation. Dense substances are
rendered thin or limpid by the process of digestion, and the urine
changes from transparency to opacity.

CLEARNESS AND TURBIDITY

632. Thick urine, as has been already stated, is sometimes
clear and translucent, sometimes turbid and opaque ; and yet
there is a marked difference between thick and limpid translucent
urine. When the former is shaken, it does not easily break up
into little portions— it only forms large portions ; and the par-
ticles move slowly ; and if it makes a foam, its foam is composed
of numerous bubbles which do not coalesce for a long time. Such
a urine is the outcome of an adequate digestion of the serous
humour, or of the vitelline bilious humour (if there be any tint
suggestive of yellowness in it) ; or of the resolution of vitreous
serous humour (if there be not any tint of yellowness in it).
The last-named variety is often found in the urine of epileptics.

But a well-coloured transparent urine owes its colour not
to digestion but to admixture with bilious humour. For other-
wise digestion would be supposed to affect only the " substance "
until a' mixture of colours had been brought about, whereas the
process of digestion effects a change of " substance " first, and
of colour secondarily. Digestion concerns " substance," not
" colour." Hence if a transparent urine is yellow, and there is

THE CANON OF MEDICINE 335

no abatement of the acute illness, that is a bad sign, for it shows
the digestive faculties are (dormant.

_The^appearance of alternating redness and yellowness in a
limpid urine points to inflammatory changes dependent on toil.
If it be limpid and shows scale-like objects in it, and if the bladder
is healthy, that is a sign of oxidation of the serous humour.

In brief, a thick urine in acute febrile states may denote
predominance of various humours, and at the same time point to
colliquative processes (in the body). Should such processes
persist during the whole phase of a disease, the urine would
become more opaque (denser, thicker).

Lastly, turbid urine denotes earthiness as well as the presence
of gas _ and wateriness. For when these qualities are combined,
turbidity is the result. -When they are separated again, the urine
becomes clear.

633, The following three states should be noted

i. The urine is clear at the time of passing, and then
becomes opaque. This shows that maturation is difficult ; that
the matter (of the food) has not yet succumbed to the vegeta-
tive powers (" nature "). It may denote colliquation in^ the
tissues.

2. The urine is opaque when passed, but then becomes
clear. The coarse matters settle and separate out. This shows
that the vegetative powers (" nature "fhave already overcome
the material (of the food) and matured it. The clearer it grows,
the_ greater the amount of sediment, and the more rapidly the
sediment falls, the more complete is the digestion.

3. A state between the above two. In this case the vege-
tative powers improve, as long as the vitality is maintained. It
shows that maturation is not progressing to completion. Rut
if the vitality is not maintained, it would mean that the matura-
tive processes are not likely to reach completion. Should this
condition persist a long time without the feared symptoms (of
loss of vitality) appearing, then it is likely that headache will
develop, for it shows that there is much gas formation.

In modern language we should say : —

Urine which is clear when passed, but is turbid on standing ; if acid, the deposit
SinL U rat ^ s ' wh ! ch f e *<* solub l e in the cold ; or (b) bacterial decomposition,
stellar and triple phosphates separating out.— We should heat the specimen
also , a cloud m an acid urine would be albumen _

brine which is turbid when passed or becomes turbid on standing ; if alkaline
the deposit is earthy phosphates (magnesium and calcium). It is met wrS
after a rich protein meal or vegetable meal. Such a urine may become
cloudy on heating, from the deposition of (calcium) phosphates, which are
soluble again if acetic acid be added. F

336 THE CANON OF MEDICINE

It is a better .sign for a clear urine to become turbid than
for it to remain turbid for several hours after being passed.

Urine may become turbid ^because of loss of vitality, apart
from expulsion of " the nature."

If urine is watery when voided, and remains so, it shows that
digestion has entirely ceased.

634, Good signs

(a) Opaque urine easily voided, whose sediment falls easily :
when occurring in palsy, etc.

(//) Urine opaque when voided but then becoming trans-
parent and plentiful.

(d) Opaque turbid urine passed at a slow rate, and then
becoming suddenly abundant and easy to void. (This means
that recovery is about to take place, whether it be an acute fever
or any other plethoric disorder, or a plethora about to manifest
as actual disease). But this kind of urine is rarely met with.

635. If the urine is of natural colour, and its opacity be
great, it is evident that much (effete) matter is passing through,
and that there is no hindrance to their outflow. But it is usually
a bad sign because it shows that the humours are superabundant,
and the vitality deficient. Such a urine is scanty and difficult

to void. . . .

Opaque urine is a good sign if it occurs at the crisis in
" splenic " diseases and " mixed " fevers, in which the emunctory
powers cannot come into play, or equipoise be restored.

Lastly, . turbid urine denotes that the humours are over-
abundant and that the vegetative powers are inadequate for their

digestion.

636. Diagnostic points. Opaque urine, with a sandy sedi-
ment, denotes calculus. Opaque urine, with pus, a bad odour,
and scaly particles separating out, denotes rupture of an abscess.
A thick urine, with the clinical evidences of an inflammatory
mass or of an ulcer in the bladder, kidney, liver or chest, shows
that there is an abscess about to burst.

If the urine prior to that were like the washings of raw meat,
it would show that there is unhealthy blood flowing from the
liver ; and if the faeces were also similar, it would show there is
an inflammatory mass in the interior of the liver. If prior to
this there was shortness of breath, with a dry cough, and a
stabbing pain in the chest, then one knows that an abscess has

THE CANON OF MEDICINE 337

ruptured which arose in the chest or (round the) aorta. If the
pus is " mature," it is satisfactory.

637. Discharge of urine resembling pus may benefit a
person who takes no exercise and lives in an unhygienic manner.
It clears the whole body, and removes the laxity resulting from
the lack of exercise. It may be that there are obstructions in
the liver andadnexa, and when the obstructions are removed,
the urine which is voided is dense owing to the matter which
passes out with it. Such " matter " is not " pus." It is only pus
if it appears m the urine after the bursting of an abscess ; the
urine is then not only thick but dark. If at this time there be
pain m the left side, then one knows that the abscess was in the
spleen. If the pain is in the upper part of the abdomen, one knows
the abscess was m the stomach. The usual site for the abscess
is m the hver and in the urinary organs.

638. Turbid urine often denotes loss of vitality ; coldness
dominates m the temperament as much as if the whole body
were exposed to external cold.

839. Turbid urine of the appearance of poor wine, or of
chick-pea-water, may occur during pregnancy, and may be met
with m persons with long-standing internal "hot" inflam-
matory masses.

640. Urine which has the extremely turbid appearance of
asses urine or the urine of other cattle, arises from the very
marked agitation which is going on in the humours, especially
the serous humour, a certain amount of heat coming into play
so as to set up that agitation. Hence this kind of urine is a fore-
runner of headache or [coryzalj catarrh in the head. If it persists,
it forewarns of lethargia.

641 If the urine resembles the colour of some member
for some time, it forewarns that disease is about to arise
there.

642. Some say that if the lower layers of the urine show a
powdery or nebulous appearance, it means that the illness will
be of long duration ; and that if it persists throughout the whole
illness, it presages death, or the formation of " crude " serous
humour, which is distinguished from pus by its fetor.

643. If the urine separates into several layers, the more
there are the stronger is the natural faculty, and the more open
are the pores. ' r

644. Threads floating in the urine denote that it was passed
immediately after completing coitus.

338 THE CANON OF MEDICINE

4. The Signs derived from the Odour of the Urine

645. Some people assert that no sick person ever passes a
urine which has a healthy odour. But we say that if the urine is
quite odourless, it denotes (a) a cold intemperament ; (b) exces-
sive " crudity " ; (c) extinction of the innate heat, in the case
of acute diseases.

648, Fetid odour. A fetid odour, with signs of maturation lii
the urine indicates ulcers in the urinary passages, or" scabies."
These are identified from their own signs. If with the fetid odour,
there are no signs of maturation, the cause of the odour may be
merely putrefaction.

Such a urine, in acute fevers, without disease in the urinary
organs, is a bad sign. If it is present in acute fevers, and there is
a tendency to acridity, it denotes putrefaction in humours which
are of a cold nature, when there is a predominance of the extra-
neous heat. . -
If such a urine appears in acute diseases, it forewarns or
' death by extinction of the innate heat and predominance of the
pyfT"? n cons cold.

'647, Sweetish odour. This denotes predominance of the
sanguineous humour. If also very fetid, a predominance of the

bilious humour.

648, Putrid odour. If this tends to sourness it shows
predominance of the atrabilious humour.

An extremely fetid odour of the urine which continues in
<;pite of seeming health denotes (a) that a fever arising from
putrefaction is coming on ; (b) expulsion of retained putrescent
matters. The latter will show whether the case may be expected
to recover. If a fetid urine appears in an acute illness, and then
suddenly ceases to be fetid, without subsidence of the symptoms,
it shows a destruction of vitality.

A moderately fetid urine denotes defective digestion : Haly Abbas.

Offensive odour may be ammoniacal, as in alkaline fermentation Sweet

odour may be " fruity » or like new-mown hay in diabetes. Specific odours result
from the use of certain drugs. (Modern.)

5. The Indications afforded by the Foam on Urine

649, Foam arises from the moisture and the gases forced
into the urine as it is passed into the urinal. The vapour which
leaves the body with the urine doubtless adds to the consistence
of the urine, especially if gases predominate in it, as occurs in
cases of obstructions. The urine then shows many bubbles.

THE CANON OF MEDICINE 339

850. One notices the following points in regard to the
foam :

(1) Colour : it is dark or reddish in jaundice.

(2) Size of bubbles : large ones indicate viscidity.

(3) Number of bubbles : if numerous it denotes viscidity
and much gas.

(4) Rate of bursting of the bubbles : if slow, it indicates
viscidity, and coarse glutinous humour.

651. Prognosis. Hence if small bubbles persist in a speci-
men, in cases of kidney disease, it shows that the illness will be
of long duration.

In brief, viscous humours in the course of kidney diseases
are of bad omen ; they show that the humours are depraved,
and cold in temperament.

The significance of small bubbles has already been stated.

6. The Indications derived from the Divers Kinds of

Sediment

852. Definition. In the first place one must specify the
meaning of the term " sediment." It is not " that which sinks
to the bottom of the vessel." It is " that whole substance (denser
in essence than wateriness) which separates out from the wateri-
ness — regardless of whether it settles down. or not, floats or not,
sinks or not."

Therefore we" may say that there are various characters
pertaining to the sediment— its " structure," its quantity and
quality, the arrangement of its components, its position, duration,
and mode of permixture.

I. STRUCTURE

[Structure ; consistence ; texture.; essential substance ;
matter ; jawhar.]

A. NATURAL SEDIMENTS

853. A sediment is natural, laudable, evidence of normal
digestion and maturation, when it is white, sinks to the bottom
of the vessel, when its particles are in continuity [i.e. not discrete],
uniform, and all alike. In contour it is rounded. It is light,
homogeneous, delicate, like the deposit which forms in rosewater.

Its relation to the maturation of the various matters of the
whole body is comparable to that to the maturation of pus.
But whereas it is white, light, and of homogeneous nature and
delicate in the former, in the case of pus it is coarse.

34 o THE CANON OF MEDICINE

654. A sediment betokens good digestion even though
devoid of colour and homogeneity * But ancient physicians
considered that homogeneity was a more important test than
colour. A homogeneous deposit — even though not altogether
white, or even if reddish in tint — is a better sign than a deposit
which is white but not homogeneous, and composed of coarse
particles. The sediment may or may not assume the same colour
as the urine. If it does not,' it is better that it should be white,
next best red, then lemon-yellow or saffron-yellow, and the least
good is that it should be like arsenicum in colour, or of a colour
like that of lentils.

However, I counsel you not to regard what others say. 1
say that — whiteness does not necessarily have a relation to the
state of digestion ; homogeneity is always related to the (efficiency
of) maturation. A thorough mingling of gaseous constituents
will produce a white effect.

If a sediment presents an unhealthy appearance, it is more
favourable that it should be discrete than continuous.

655. Good sediments resemble pus and crude serous
humour when they are tenuqus. But pus is different in possessing
fetor, crude serous humour is different in (rendering the deposit)
compact and not homogeneous. A good sediment differs from
both because it is finely textured and light.

656. One would not expect to find such a deposit in a person
who is healthy ; it occurs in the sick person because mattersare
kept back in his blood-vessels, and they undergo (putrefactive)
breakdown if they cannot be subjected to maturation. In health,
the blood need not necessarily contain a humour which ought to
be removed, but if there were such a humour present, it would
be better if it were disposed of by way of the faeces (the indi-
gestible excess in the aliments) than if it emerge by way of the
urine as a sediment — whether such humour have undergone
maturation or not. .

In thin persons, the sediment of the urine is scanty and it
sinks down differently according to the state of health, especially
if the persons are accustomed to exercise or to practise laborious

arts.

The sediment is abundant only in obese persons ana in those

of bad habits.

657o Hence one does not expect to find as much sediment
in sick persons who are lean as in those who are stout. For

* The general significance of a sediment is that there is an excess of soluble
or insoluble toxic substances in the blood.

THE CANON OF MEDICINE 34I

disease in the former often resolves without any sediment forming
at all. At most there may be a tiny particle floating or swimmin^
in it. _ In other cases the sediment falls immediately after
micturition unless there is good maturation—in which case
very little deposit is to be expected.

B. _ ABNORMAL SEDIMENTS

658 Varieties, (i) Flaky or squamous ; (2) fleshy ; (>>)
fatty; (4) mucoid or slimy; (5) purulent (ichorous) ; (6) hair-like-
(7; resembling pieces of yeast infused in water ; (8) sandy or
gritty ; (9) cineritial ; (10) hirudiniform.

i. Flaky or squamous. This is composed of laro- e red or
large white particles. They are usually supposed to cSme from
the urinary organs. If white, they come from the bladder
(ulceration, desquamation, erosions) ; if red or fleshy, they come
from the kidney. If brown or dark coloured, or like the scales
of fishes, they are a very bad sign, worse than all which we have
named. They suggest the shedding of mucous linings. Parti-
cles from the bladder or kidneys may not be of moment ; in
fact if vesical they are a sign of recovery. Some say that can-
thandes causes white flakes to appear, which are like the mem-
brane within eggs ; these dissolve when the specimen is shaken
and impart a reddish tint to the urine. This would be evidence
of healing and recovery.

Another form resembles the scrapings from intestines •
the particles being less broad and of dense consistence If
reddish coloured it is called orobeal [or tare-like or grumous]
sediment ; otherwise it is called furfuraceous. The former
recalls the appearance of decorticated orobs [ervum ervilial, and
are reddish ; this indicates the presence of oxidized particles*
which are derived from {a) the liver, (b) the kidney, or (c) blood.
When they come from the kidney, the particles are more con-
tinuous and fleshy, whereas in the other cases they are more
friable When the colour is decidedly yellowish (one knows
that) theyare of renal origin ; if dusky red (that) they are of
hepatic origin. But sometimes particles of hepatic origin may
resemble those of renal origin.

Another form, more strictly scaly, consists of small bodies

l!rL S ° r huUs ° f S rain - Such a se diment denotes (i)

bladder trouble, or (11) grave colliquative disorder of the system
as a whole. We diagnose (i) bladder trouble if (1) there is itching

* The mineral constituents

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